Healthcare Provider Details

I. General information

NPI: 1831085455
Provider Name (Legal Business Name): MARLA M REPPOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 10TH ST STE B
ROLLA MO
65401-3591
US

IV. Provider business mailing address

PO BOX 528
CUBA MO
65453-0528
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-9616
  • Fax: 573-341-3986
Mailing address:
  • Phone: 573-885-0885
  • Fax: 573-677-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2025018655
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: