Healthcare Provider Details

I. General information

NPI: 1497739197
Provider Name (Legal Business Name): MARY HELEN NEDRY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 N M 37 HWY
MIDDLEVILLE MI
49333-8806
US

IV. Provider business mailing address

909 W MAIN ST
MIDDLEVILLE MI
49333-9770
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-7936
  • Fax:
Mailing address:
  • Phone: 269-795-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: