Provider Demographics
NPI:1295757409
Name:DEAN, MARY DENISE (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:DENISE
Last Name:DEAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 HOWLAND DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3601
Mailing Address - Country:US
Mailing Address - Phone:614-752-0176
Mailing Address - Fax:614-752-0056
Practice Address - Street 1:416 HOWLAND DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3601
Practice Address - Country:US
Practice Address - Phone:614-752-0176
Practice Address - Fax:614-752-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist