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General NPI Number Information
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NPI Number | 1174078232
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Entity Type | Individual
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Provider Name | MARISA REEVES
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Gender | Female
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 32905 FORT RD
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City | ROCKWOOD
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State | MI
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Zip | 48173-1112
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Country | US
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Telephone | 734-379-9633
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 E 450 S STE A
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City | WHITESTOWN
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State | IN
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Zip | 46075-8404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302041906
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26027796A
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License Number State | IN
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