Provider Demographics
NPI:1184215360
Name:HOWARD, MARY L (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
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 1:23112 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-4445
Mailing Address - Country:US
Mailing Address - Phone:636-390-3173
Mailing Address - Fax:
Practice Address - Street 1:1330 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3431
Practice Address - Country:US
Practice Address - Phone:636-390-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist