Healthcare Provider Details

I. General information

NPI: 1568821908
Provider Name (Legal Business Name): MARLENE BERRO PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 02/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OLDS ST
JONESVILLE MI
49250-9477
US

IV. Provider business mailing address

701 OLDS ST
JONESVILLE MI
49250-9477
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-7011
  • Fax:
Mailing address:
  • Phone: 517-849-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302031573
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: