Provider Demographics
NPI:1588948343
Name:DEWITT, MARTHA ANDERSON (RPH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANDERSON
Last Name:DEWITT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8131
Mailing Address - Country:US
Mailing Address - Phone:502-228-3304
Mailing Address - Fax:502-228-3584
Practice Address - Street 1:5900 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8131
Practice Address - Country:US
Practice Address - Phone:502-228-3304
Practice Address - Fax:502-228-3584
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010580183500000X
AL11351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist