Provider Demographics
NPI:1457437766
Name:OSTERHAUS, MARILYN S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:S
Last Name:OSTERHAUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-3034
Mailing Address - Country:US
Mailing Address - Phone:563-652-5567
Mailing Address - Fax:563-652-6242
Practice Address - Street 1:124 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3034
Practice Address - Country:US
Practice Address - Phone:563-652-5567
Practice Address - Fax:563-652-6242
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAO-15764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist