Provider Demographics
NPI:1003227752
Name:HOWARD, MARY JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:HOWARD
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 1:5044 CEDAR RIDGE ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1212
Mailing Address - Country:US
Mailing Address - Phone:616-363-7228
Mailing Address - Fax:
Practice Address - Street 1:1801 MARKETPLACE DR SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-8506
Practice Address - Country:US
Practice Address - Phone:616-656-6110
Practice Address - Fax:616-656-6165
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist