Provider Demographics
NPI:1144226689
Name:MARSHALL, MARYBETH AVRIPAS (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:AVRIPAS
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:ANN
Other - Last Name:AVRIPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:43 OLDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3010
Mailing Address - Country:US
Mailing Address - Phone:248-858-3787
Mailing Address - Fax:248-858-3794
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:# H-13
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3787
Practice Address - Fax:248-858-3794
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist