Provider Demographics
NPI:1497739197
Name:NEDRY, MARY HELEN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HELEN
Last Name:NEDRY
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 1:909 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-9770
Mailing Address - Country:US
Mailing Address - Phone:269-795-3166
Mailing Address - Fax:
Practice Address - Street 1:4652 N M 37 HWY
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8806
Practice Address - Country:US
Practice Address - Phone:269-795-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1964469Medicaid
MI2540648Medicaid
MI5302033226OtherREG. PHARMACIST LICENSE
MI1964469Medicaid