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NPI Code Detail

MEDICARE: THERESA MAHONEY PHARMD

MEDICARE: THERESA MAHONEY PHARMD
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
1183500000XPharmacist010878KY

General Provider Information

NPI Number : 1609704816
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA MAHONEY PHARMD
Provider Business Mailing Address
First Line : 267 ICETOWN RD
Second Line :
City : BOSTON
State : KY
Zip : 40107-8446
Country : US
Telephone Number : 502-275-6572
Fax Number :
Provider Business Practice Location Address
First Line : 320 N LORETTO RD
Second Line :
City : LEBANON
State : KY
Zip : 40033-1300
Country : US
Telephone Number : 270-692-5276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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Directions to “ THERESA MAHONEY PHARMD” Practice Location

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