Provider Demographics
NPI:1710627005
Name:HUBER, MARIANN SUSAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:SUSAN
Last Name:HUBER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARIANN
Other - Middle Name:SUSAN
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1310 SE 14TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3700
Mailing Address - Country:US
Mailing Address - Phone:440-536-1204
Mailing Address - Fax:
Practice Address - Street 1:2710 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5788
Practice Address - Country:US
Practice Address - Phone:239-574-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221519183500000X
FLPS41807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist