Provider Demographics
NPI:1144583006
Name:FROST, MARNE J (RPH)
Entity Type:Individual
Prefix:
First Name:MARNE
Middle Name:J
Last Name:FROST
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 1:301 MARYSVILLE MALL # 60
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5502
Mailing Address - Country:US
Mailing Address - Phone:360-659-8952
Mailing Address - Fax:360-659-2802
Practice Address - Street 1:301 MARYSVILLE MALL # 60
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5502
Practice Address - Country:US
Practice Address - Phone:360-659-8952
Practice Address - Fax:360-659-2802
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020323183500000X
MTPHA-PHA-LIC-3555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist