Healthcare Provider Details

I. General information

NPI: 1194732560
Provider Name (Legal Business Name): MARY ELIZABETH ENZWEILER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MAIN ST
AUGUSTA KY
41002-1037
US

IV. Provider business mailing address

3164 ROYAL WINDSOR DR
EDGEWOOD KY
41017-2691
US

V. Phone/Fax

Practice location:
  • Phone: 606-756-2204
  • Fax: 606-756-2702
Mailing address:
  • Phone: 859-331-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-17174
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9082
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: