Provider Demographics
NPI:1184014144
Name:GUDE, MARY (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GUDE
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 1:33101 SAINT JOE RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-0300
Mailing Address - Country:US
Mailing Address - Phone:352-424-1945
Mailing Address - Fax:
Practice Address - Street 1:33101 SAINT JOE RD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-0300
Practice Address - Country:US
Practice Address - Phone:352-424-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist