Provider Demographics
NPI:1467739524
Name:MARJALA, ANDREW RAYMOND (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RAYMOND
Last Name:MARJALA
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 1:200 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3023
Mailing Address - Country:US
Mailing Address - Phone:612-827-8902
Mailing Address - Fax:612-827-4180
Practice Address - Street 1:200 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3023
Practice Address - Country:US
Practice Address - Phone:612-827-8902
Practice Address - Fax:612-827-4180
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist