Provider Demographics
NPI:1992041776
Name:DEGREEN, MARIANNE K (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:K
Last Name:DEGREEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2600
Mailing Address - Country:US
Mailing Address - Phone:570-784-9582
Mailing Address - Fax:570-389-1622
Practice Address - Street 1:1000 MARKET ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2600
Practice Address - Country:US
Practice Address - Phone:570-784-9582
Practice Address - Fax:570-389-1622
Is Sole Proprietor?:No
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist