Healthcare Provider Details

I. General information

NPI: 1194290361
Provider Name (Legal Business Name): MARYANNE MARIE GELLINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 MAIN ST
VANCOUVER WA
98660-2649
US

IV. Provider business mailing address

16013 NE 4TH ST
VANCOUVER WA
98684-3329
US

V. Phone/Fax

Practice location:
  • Phone: 360-693-2524
  • Fax:
Mailing address:
  • Phone: 360-241-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60872073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: