Provider Demographics
NPI:1285491266
Name:ROWE, MARYDEA (PHARMD)
Entity type:Individual
Prefix:
First Name:MARYDEA
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 FOREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41527-8330
Mailing Address - Country:US
Mailing Address - Phone:606-625-3377
Mailing Address - Fax:
Practice Address - Street 1:1211 FOREST HILLS RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:KY
Practice Address - Zip Code:41527-8330
Practice Address - Country:US
Practice Address - Phone:606-625-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist