Provider Demographics
NPI:1750482816
Name:HOUGH, MARY C (BS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:HOUGH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MILL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-3014
Mailing Address - Country:US
Mailing Address - Phone:850-926-7340
Mailing Address - Fax:
Practice Address - Street 1:111 S MAGNOLIA DR STE 39
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2958
Practice Address - Country:US
Practice Address - Phone:850-656-3414
Practice Address - Fax:850-877-5916
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0033381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist