Healthcare Provider Details

I. General information

NPI: 1912722455
Provider Name (Legal Business Name): MARAH HART PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARAH ST. JOHN PHARMD

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MORNINGSIDE AVE
SIOUX CITY IA
51106-2486
US

IV. Provider business mailing address

645 STREETER DR APT 306
NORTH SIOUX CITY SD
57049-4134
US

V. Phone/Fax

Practice location:
  • Phone: 712-276-4621
  • Fax:
Mailing address:
  • Phone: 507-532-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25561
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number126665
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: