Provider Demographics
NPI:1962590182
Name:RIDGWAY, KAREN M (RPH)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:RIDGWAY
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 1:2215 SYCAMORE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1288
Mailing Address - Country:US
Mailing Address - Phone:937-428-7828
Mailing Address - Fax:
Practice Address - Street 1:3101 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2139
Practice Address - Country:US
Practice Address - Phone:937-254-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-16881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964907Medicaid
OH0964907Medicaid