Provider Demographics
NPI:1922696392
Name:MARWEG, HOLLY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:MARWEG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SAINT MICHAEL PKWY APT 313
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-2203
Mailing Address - Country:US
Mailing Address - Phone:763-614-7916
Mailing Address - Fax:
Practice Address - Street 1:21455 JOHN MILLESS DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9431
Practice Address - Country:US
Practice Address - Phone:763-428-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist