Provider Demographics
NPI:1477650810
Name:WYANT, MARY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:WYANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:DEPT 119
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-287-6179
Mailing Address - Fax:502-287-6967
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:DEPT 119
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206
Practice Address - Country:US
Practice Address - Phone:502-287-6179
Practice Address - Fax:502-287-6967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist