Healthcare Provider Details

I. General information

NPI: 1316590771
Provider Name (Legal Business Name): MARY KATHERINE CULP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 01/10/2023
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E PALMER RD
BELLEFONTAINE OH
43311-2281
US

IV. Provider business mailing address

205 E PALMER RD
BELLEFONTAINE OH
43311-2298
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-4015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03438895
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: