Provider Demographics
NPI:1255464319
Name:CHAMBERLAIN, MARY ELLEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:CHAMBERLAIN
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 1:576 SMITHFIELD PL
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3316
Mailing Address - Country:US
Mailing Address - Phone:352-638-0399
Mailing Address - Fax:
Practice Address - Street 1:4085 WEDGE WOOD LANE
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-259-2844
Practice Address - Fax:352-259-3317
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39456183500000X
MI22501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist