MEDICARE: MARLEE RISEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	17568	WI

General Provider Information

NPI Number	:	1184024333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEE RISEN PHARMD

Provider Business Mailing Address
First Line	:	2024 MOUNT WELCOME STE 11
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-3610
Country	:	US
Telephone Number	:	340-719-7283
Fax Number	:	340-719-7284

Provider Business Practice Location Address
First Line	:	2024 MOUNT WELCOME STE 11
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-3610
Country	:	US
Telephone Number	:	340-719-7283
Fax Number	:	340-719-7284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	10/25/2022

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