Provider Demographics
NPI:1952372674
Name:BISHOP, MARY R (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:R
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12000 HUDSON VIEW CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-8326
Mailing Address - Country:US
Mailing Address - Phone:502-587-9436
Mailing Address - Fax:502-561-5342
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:WINGS CLINIC, ACB 2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-561-5340
Practice Address - Fax:502-561-5342
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY10557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist