Provider Demographics
NPI:1770911752
Name:JEWELL, MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14409 CHAMPION WOODS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5202
Mailing Address - Country:US
Mailing Address - Phone:502-749-3388
Mailing Address - Fax:502-749-3389
Practice Address - Street 1:12501 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1530
Practice Address - Country:US
Practice Address - Phone:502-244-7960
Practice Address - Fax:502-244-7982
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012665183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26028475AOtherBOARD OF PHARMACY
KY012665OtherBOARD OF PHARMACY