Provider Demographics
NPI:1619009909
Name:MARAIS, WILLEM (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLEM
Middle Name:
Last Name:MARAIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-7627
Mailing Address - Country:US
Mailing Address - Phone:805-305-1938
Mailing Address - Fax:541-271-6369
Practice Address - Street 1:600 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1795
Practice Address - Country:US
Practice Address - Phone:541-271-6370
Practice Address - Fax:541-271-6369
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist