Provider Demographics
NPI:1558662775
Name:WURSTER, MARJORIE (RPH)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:WURSTER
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:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-0476
Mailing Address - Country:US
Mailing Address - Phone:303-209-5274
Mailing Address - Fax:303-209-5275
Practice Address - Street 1:3851 EVERGREEN PARKWAY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:303-209-5274
Practice Address - Fax:303-209-5275
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist