Provider Demographics
NPI:1437835378
Name:OWENS, MARY KAY KATHRYN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY KAY
Middle Name:KATHRYN
Last Name:OWENS
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 1:3019 NORTH SHANNON LAKES DRIVE SUITE 202
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309
Mailing Address - Country:US
Mailing Address - Phone:850-668-8524
Mailing Address - Fax:850-668-6587
Practice Address - Street 1:3019 NORTH SHANNON LAKES DRIVE SUITE 202
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309
Practice Address - Country:US
Practice Address - Phone:850-668-8524
Practice Address - Fax:850-668-6587
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist