Provider Demographics
NPI:1699813998
Name:WURTH, MARK S (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:WURTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1556 STEAMBOAT RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42044-8704
Mailing Address - Country:US
Mailing Address - Phone:270-965-4101
Mailing Address - Fax:270-965-9957
Practice Address - Street 1:520 W GUM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1516
Practice Address - Country:US
Practice Address - Phone:270-965-4101
Practice Address - Fax:270-965-9957
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist