Healthcare Provider Details

I. General information

NPI: 1477544567
Provider Name (Legal Business Name): MARCELLA ELAINE FUNDUM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CALUMET ST
LAKE LINDEN MI
49945-1310
US

IV. Provider business mailing address

201 TAMARACK ST
LAURIUM MI
49913-2113
US

V. Phone/Fax

Practice location:
  • Phone: 906-296-6341
  • Fax: 906-296-9341
Mailing address:
  • Phone: 906-337-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: