Provider Demographics
NPI:1598844086
Name:MAZE, JAMES DALE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DALE
Last Name:MAZE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:DALE
Other - Last Name:MAZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2050 HIGHWAY 11 NORTH
Mailing Address - Street 2:PO BOX 1108
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314
Mailing Address - Country:US
Mailing Address - Phone:606-593-0382
Mailing Address - Fax:606-593-0384
Practice Address - Street 1:2050 HIGHWAY 11 NORTH
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314
Practice Address - Country:US
Practice Address - Phone:606-593-0382
Practice Address - Fax:606-593-0384
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist