Provider Demographics
NPI:1114147964
Name:CHOROBA, MARYANN L (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:L
Last Name:CHOROBA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39774 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1524
Mailing Address - Country:US
Mailing Address - Phone:734-664-9350
Mailing Address - Fax:
Practice Address - Street 1:6100 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3683
Practice Address - Country:US
Practice Address - Phone:734-981-3002
Practice Address - Fax:734-981-0644
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2001-1903-2499-379183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician