Healthcare Provider Details

I. General information

NPI: 1699813998
Provider Name (Legal Business Name): MARK S. WURTH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W GUM ST
MARION KY
42064-1516
US

IV. Provider business mailing address

1556 STEAMBOAT RD
GILBERTSVILLE KY
42044-8704
US

V. Phone/Fax

Practice location:
  • Phone: 270-965-4101
  • Fax: 270-965-9957
Mailing address:
  • Phone: 270-965-4101
  • Fax: 270-965-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008088
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: