Provider Demographics
NPI:1215213327
Name:PICKARD, MARCUS E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:E
Last Name:PICKARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6351
Mailing Address - Country:US
Mailing Address - Phone:608-362-6047
Mailing Address - Fax:608-362-6480
Practice Address - Street 1:910 BROAD ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6351
Practice Address - Country:US
Practice Address - Phone:608-362-6047
Practice Address - Fax:608-362-6480
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13146-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist