Provider Demographics
NPI:1174609044
Name:DENTON, MARIE AJ (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:AJ
Last Name:DENTON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MEDICAL CIRCLE
Mailing Address - Street 2:SAINT CLAIRE REGIONAL MEDICAL CENTER PHARMACY
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1180
Mailing Address - Country:US
Mailing Address - Phone:606-783-6742
Mailing Address - Fax:606-783-6693
Practice Address - Street 1:109 ROSELAWN LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-9738
Practice Address - Country:US
Practice Address - Phone:606-784-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist