Provider Demographics
NPI:1023332632
Name:LEVY, MARY ELLEN (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:LEVY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GALBRAITH
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:103 E MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2461
Mailing Address - Country:US
Mailing Address - Phone:816-380-3321
Mailing Address - Fax:816-887-5206
Practice Address - Street 1:103 E MECHANIC ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2461
Practice Address - Country:US
Practice Address - Phone:816-380-3321
Practice Address - Fax:816-887-5206
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO41172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist