Provider Demographics
NPI:1578750618
Name:MA-BURRELL, MARLENE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:MA-BURRELL
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 1:24090 ITHACA ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3709
Mailing Address - Country:US
Mailing Address - Phone:248-514-2412
Mailing Address - Fax:
Practice Address - Street 1:24090 ITHACA ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3709
Practice Address - Country:US
Practice Address - Phone:248-514-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist