Provider Demographics
NPI:1851063895
Name:GAPPY, MARNA MUSIB
Entity Type:Individual
Prefix:
First Name:MARNA
Middle Name:MUSIB
Last Name:GAPPY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7088 YARMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1077
Mailing Address - Country:US
Mailing Address - Phone:248-909-8628
Mailing Address - Fax:
Practice Address - Street 1:2990 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1414
Practice Address - Country:US
Practice Address - Phone:248-541-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413830183500000X
MI5315229034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist