Provider Demographics
NPI:1346569043
Name:GAUT, MARILYN JEANNE (RPH)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEANNE
Last Name:GAUT
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 1:37980 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3431
Mailing Address - Country:US
Mailing Address - Phone:734-464-2440
Mailing Address - Fax:734-464-0383
Practice Address - Street 1:37980 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3431
Practice Address - Country:US
Practice Address - Phone:734-464-2440
Practice Address - Fax:734-464-0383
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist