Healthcare Provider Details

I. General information

NPI: 1770911752
Provider Name (Legal Business Name): MARIE JEWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 SHELBYVILLE RD
LOUISVILLE KY
40243-1530
US

IV. Provider business mailing address

14409 CHAMPION WOODS PL
LOUISVILLE KY
40245-5202
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-7960
  • Fax: 502-244-7982
Mailing address:
  • Phone: 502-749-3388
  • Fax: 502-749-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012665
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number012665
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: