Provider Demographics
NPI:1770869430
Name:STEWART, MARISA WELLING (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:WELLING
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 RETVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9368
Mailing Address - Country:US
Mailing Address - Phone:513-520-6118
Mailing Address - Fax:513-791-6579
Practice Address - Street 1:11700 RETVIEW LN
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9368
Practice Address - Country:US
Practice Address - Phone:513-520-6118
Practice Address - Fax:513-791-6579
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist