Provider Demographics
NPI:1578553715
Name:PAUL, MARIANNE (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 WAKARA WAY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1244
Mailing Address - Country:US
Mailing Address - Phone:801-581-6266
Mailing Address - Fax:
Practice Address - Street 1:421 WAKARA WAY
Practice Address - Street 2:SUITE 208
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1244
Practice Address - Country:US
Practice Address - Phone:801-581-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT366938-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist