MEDICARE: MARTHA ANDERSON DEWITT 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	010580	KY
2	183500000X	Pharmacist	11351	AL

General Provider Information

NPI Number	:	1588948343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA ANDERSON DEWITT R.PH.

Provider Business Mailing Address
First Line	:	5900 TIMBER RIDGE DR
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-8131
Country	:	US
Telephone Number	:	502-228-3304
Fax Number	:	502-228-3584

Provider Business Practice Location Address
First Line	:	5900 TIMBER RIDGE DR
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-8131
Country	:	US
Telephone Number	:	502-228-3304
Fax Number	:	502-228-3584

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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