Provider Demographics
NPI:1336271998
Name:MILLONIG, MARSHA KATHERINE (BS, MBA)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:KATHERINE
Last Name:MILLONIG
Suffix:
Gender:F
Credentials:BS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 DONEENE LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1172
Mailing Address - Country:US
Mailing Address - Phone:651-905-9002
Mailing Address - Fax:651-905-9004
Practice Address - Street 1:3153 DONEENE LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1172
Practice Address - Country:US
Practice Address - Phone:651-905-9002
Practice Address - Fax:651-905-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113665-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist