Provider Demographics
NPI:1730106394
Name:ALDRICH, MARILYN J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:J
Last Name:ALDRICH
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 1:4710 63RD ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-8208
Mailing Address - Country:US
Mailing Address - Phone:515-270-1086
Mailing Address - Fax:
Practice Address - Street 1:3425 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3915
Practice Address - Country:US
Practice Address - Phone:515-255-8642
Practice Address - Fax:515-255-6099
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist