1538509187 NPI number — DR. MARY JOSEPHINE TROUT PHARM.D.

Table of content: DR. MARY JOSEPHINE TROUT PHARM.D. (NPI 1538509187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538509187 NPI number — DR. MARY JOSEPHINE TROUT PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROUT
Provider First Name:
MARY
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCARTHY
Provider Other First Name:
MARY
Provider Other Middle Name:
JOSEPHINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.PH.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538509187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290L WHITE HL
Provider Second Line Business Mailing Address:
3640 COLONEL GLENN HWY
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45435-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-775-3820
Provider Business Mailing Address Fax Number:
937-775-2842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 E APPLE ST
Provider Second Line Business Practice Location Address:
SUITE 1820
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-208-6692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  03316136 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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