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General NPI Number Information
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NPI Number | 1316042005
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Entity Type | Individual
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Provider Name | MRS. LAURA JEAN MARASCO
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 OVERLOOK TER
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City | MADISON
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State | WI
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Zip | 53705-2254
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Country | US
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Telephone | 608-256-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 13478 RAVINE VIEW DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-9179
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Country | US
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Telephone | 616-842-0275
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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 | 5302034012
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License Number State | MI
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