Provider Demographics
NPI:1467507194
Name:DEPEW, G. ELDON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:ELDON
Last Name:DEPEW
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CHIPPEWA LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1005
Mailing Address - Country:US
Mailing Address - Phone:606-878-9103
Mailing Address - Fax:
Practice Address - Street 1:214 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-1204
Practice Address - Country:US
Practice Address - Phone:606-598-6736
Practice Address - Fax:606-599-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist