MRS. MARY JO WITHERED (NPI# 1679868285) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679868285 |
| Entity Type | Individual |
| Full Name | MRS. MARY JO WITHERED |
| Credential | REGISTERED PHARMACIS |
| Practice Address |
3630 State Road 26 E T-1762 Lafayette IN 47905-4807 |
| Practice Telephone | 7654474411 |
| Mailing Telephone | 7654474411 |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2011-06-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | IN26013681A | IN | Pharmacy Service Providers |
| Street Address |
3630 STATE ROAD 26 E T-1762 |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905-4807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114244043 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 3630 State Road 26 E, Lafayette, IN 47905-4807 | 2010-05-03 |
| 1013202506 | Kary G Mckinley | Pharmacist | 3630 State Road 26 E, Lafayette, IN 47905-4807 | 2011-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1447569538 | Deidre Dudley | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905 | 2010-10-07 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| Find all providers in zip 47905 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396390613 | Patience Bergeron | Pharmacist | 118 Keelingwood Ln, Lafayette, LA 70507-3254 | 2019-08-04 |
| 1659924439 | Le Nguyen | Pharmacist | 620 Guilbeau Rd Ste A, Lafayette, LA 70506-8709 | 2019-07-19 |
| 1730731969 | Kevin Lagrange | Pharmacist | 107 Kentville Cir, Lafayette, LA 70508-6458 | 2019-07-09 |
| 1750857926 | Spree Chisley | Pharmacist | 103 Glasgow Dr, Lafayette, LA 70508-7050 | 2018-10-15 |
| 1780162586 | Chelsie Morein Head | Pharmacist | 1630 Rue Du Belier Apt 301, Lafayette, LA 70506-6549 | 2018-08-02 |
| 1023505914 | Heather Staton | Pharmacist | 324 W. Patton Street, Lafayette, GA 30728 | 2018-04-17 |
| 1205349784 | Natalie Schwartzel | Pharmacist | 987 S Creasy Ln, Lafayette, IN 47905-4800 | 2017-11-07 |
| 1114439320 | Angelle Marie Voinche | Pharmacist | 5000 Ambassador Caffery Pkwy Bldg 3 Ste B, Lafayette, LA 70508-6984 | 2017-10-27 |
| 1245680743 | Kaleab Alamrew | Pharmacist | 1701 Ambassador Caffery Pkwy, Lafayette, LA 70506-2803 | 2016-06-15 |
| 1003285677 | Philip Asare | Pharmacist | 2517 Kaliste Saloon Rd, Lafayette, LA 70508 | 2015-09-24 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.