MEDICARE: DR. MARSHA STREET PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20586	IA

General Provider Information

NPI Number	:	1225313265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHA STREET PHARMD

Provider Business Mailing Address
First Line	:	4555 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2331
Country	:	US
Telephone Number	:	515-287-5575
Fax Number	:	515-287-1718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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Directions to “ DR. MARSHA STREET PHARMD” Practice Location

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