Provider Demographics
NPI:1205435344
Name:MARQUARDT, ANGELA LOU
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOU
Last Name:MARQUARDT
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 1:2786 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5031
Mailing Address - Country:US
Mailing Address - Phone:715-738-2418
Mailing Address - Fax:715-738-2425
Practice Address - Street 1:2786 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5031
Practice Address - Country:US
Practice Address - Phone:715-738-2418
Practice Address - Fax:715-738-2425
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist