Provider Demographics
NPI:1508843350
Name:NIEDERKOHR, MARJORIE A (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:A
Last Name:NIEDERKOHR
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 1:386 LIGHTHOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3639
Mailing Address - Country:US
Mailing Address - Phone:937-886-9888
Mailing Address - Fax:
Practice Address - Street 1:2601 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-2641
Practice Address - Country:US
Practice Address - Phone:937-253-3166
Practice Address - Fax:937-253-3165
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist