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General NPI Number Information
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NPI Number | 1750163549
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Entity Type | Individual
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Provider Name | MARISSA STRASEL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 2410 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4806
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Country | US
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Telephone | 616-949-5710
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 EASTWOOD AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3579
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Country | US
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Telephone | 989-928-5032
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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 | 5302415549
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License Number State | MI
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