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NPI Code Detail

MEDICARE: DR. MARISSA L MCCLUSKEY PHARMD, MBA

MEDICARE: DR. MARISSA L MCCLUSKEY PHARMD, MBA
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
1183500000XPharmacist119848MN

General Provider Information

NPI Number : 1376775064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARISSA L MCCLUSKEY PHARMD, MBA
Provider Business Mailing Address
First Line : 3620 TEXAS AVE S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-4057
Country : US
Telephone Number : 952-933-3177
Fax Number : 952-933-4187
Provider Business Practice Location Address
First Line : 3620 TEXAS AVE S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-4057
Country : US
Telephone Number : 952-933-3177
Fax Number : 952-933-4187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2009
Last Update Date : 08/14/2009

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