Provider Demographics
NPI:1538509187
Name:TROUT, MARY JOSEPHINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPHINE
Last Name:TROUT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOSEPHINE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:290L WHITE HL
Mailing Address - Street 2:3640 COLONEL GLENN HWY
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-775-3820
Mailing Address - Fax:937-775-2842
Practice Address - Street 1:128 E APPLE ST
Practice Address - Street 2:SUITE 1820
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2902
Practice Address - Country:US
Practice Address - Phone:937-208-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033161361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy