Provider Demographics
NPI:1447249180
Name:MAHONEY, MARY ELLA (PHARMD, BCOP)
Entity type:Individual
Prefix:DR
First Name:MARY ELLA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:DR
Other - First Name:MARY ELLA
Other - Middle Name:
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, BCOP
Mailing Address - Street 1:8701 COCO PLUM PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-6860
Mailing Address - Country:US
Mailing Address - Phone:321-843-1014
Mailing Address - Fax:321-841-6471
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:MP 720
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:321-843-1014
Practice Address - Fax:321-841-6471
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist