Provider Demographics
NPI:1659681286
Name:RIDGE, MARY E (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:RIDGE
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 1:37943 EILAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2523
Mailing Address - Country:US
Mailing Address - Phone:813-788-0224
Mailing Address - Fax:813-780-1031
Practice Address - Street 1:37943 EILAND BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2523
Practice Address - Country:US
Practice Address - Phone:813-788-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-17
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 41120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist