Provider Demographics
NPI:1356059604
Name:KNORR, MARISA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ELIZABETH
Last Name:KNORR
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 1:847 BUNTING ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8521
Mailing Address - Country:US
Mailing Address - Phone:570-789-1265
Mailing Address - Fax:
Practice Address - Street 1:26 W INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5300
Practice Address - Country:US
Practice Address - Phone:570-648-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist