Provider Demographics
NPI:1003196734
Name:MARASS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MARASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5269
Mailing Address - Country:US
Mailing Address - Phone:207-893-2562
Mailing Address - Fax:207-893-2568
Practice Address - Street 1:741 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5269
Practice Address - Country:US
Practice Address - Phone:207-893-2562
Practice Address - Fax:207-893-2568
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4573183500000X
IN26017322A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist