Basic Information
Provider Information
NPI: 1114980844
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOWNSEND
FirstName: MARY
MiddleName: LOUISE
NamePrefix: DR.
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1207 GOLDENVIEW CT
Address2:  
City: DURHAM
State: NC
PostalCode: 277138208
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber:  
Practice Location
Address1: 508 FULTON ST
Address2: PHARMACY DEPARTMENT
City: DURHAM
State: NC
PostalCode: 277053875
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X15837NCY Pharmacy Service ProvidersPharmacist 

No ID Information.


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