Provider Demographics
NPI:1073631768
Name:MARNERIS, ANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:MARNERIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10612 S CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3102
Mailing Address - Country:US
Mailing Address - Phone:773-445-3503
Mailing Address - Fax:
Practice Address - Street 1:8700 S CICERO AVE
Practice Address - Street 2:DOMINICK'S PHARMACY
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1372
Practice Address - Country:US
Practice Address - Phone:708-422-0471
Practice Address - Fax:708-424-7058
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist