Provider Demographics
NPI:1982264198
Name:MIDDLETON, MARK R (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S SUGAR ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9607
Mailing Address - Country:US
Mailing Address - Phone:740-404-3686
Mailing Address - Fax:
Practice Address - Street 1:735 N WATER ST
Practice Address - Street 2:
Practice Address - City:UHRICHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44683-1455
Practice Address - Country:US
Practice Address - Phone:740-922-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist