Provider Demographics
NPI:1366037533
Name:STURDY, MARY GWEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GWEN
Last Name:STURDY
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 1:3201 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2001
Mailing Address - Country:US
Mailing Address - Phone:785-623-0025
Mailing Address - Fax:
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-2402
Practice Address - Country:US
Practice Address - Phone:785-346-2136
Practice Address - Fax:785-346-5898
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9480183500000X
KS1-10040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist