Provider Demographics
NPI:1609129345
Name:LARKIN, MARY OGIELA (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:OGIELA
Last Name:LARKIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:H
Other - Last Name:OGIELA-BAZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-0594
Mailing Address - Country:US
Mailing Address - Phone:715-421-5869
Mailing Address - Fax:
Practice Address - Street 1:610 15TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4919
Practice Address - Country:US
Practice Address - Phone:715-421-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
WI14015-40183500000X
NMRP00004262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator