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General NPI Number Information
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NPI Number | 1528330024
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Entity Type | Individual
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Provider Name | MARLIES ELAINE MATHIS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/31/2012
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 1000 4TH ST SW ACUTE CARE PHARMACY
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City | MASON CITY
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State | IA
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Zip | 50401-2800
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Country | US
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Telephone | 641-428-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 BRIARSTONE DR
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City | MASON CITY
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State | IA
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Zip | 50401-4639
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Country | US
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Telephone | 641-210-7009
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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 | 21101
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License Number State | IA
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