MEDICARE: MARLA R TONN

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	16888	IA

General Provider Information

NPI Number	:	1922062843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA R TONN

Provider Business Mailing Address
First Line	:	555 W CHERRY ST
Second Line	:	PO BOX 287
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9797
Country	:	US
Telephone Number	:	319-626-6188
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 W CHERRY ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9797
Country	:	US
Telephone Number	:	319-626-6188
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	02/28/2008

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