MEDICARE: MRS. MARY LOU MONTENERY R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-2-09400	OH

General Provider Information

NPI Number	:	1578552451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LOU MONTENERY R.PH.

Provider Business Mailing Address
First Line	:	8 FOX CHASE DR
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-8209
Country	:	US
Telephone Number	:	740-397-5865
Fax Number	:	740-392-7576

Provider Business Practice Location Address
First Line	:	812 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1947
Country	:	US
Telephone Number	:	740-393-3784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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