Provider Demographics
NPI:1811265473
Name:INGLAND, MARILYN DIANE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:DIANE
Last Name:INGLAND
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4494 GRAPE VINE DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7295
Mailing Address - Country:US
Mailing Address - Phone:517-546-0573
Mailing Address - Fax:
Practice Address - Street 1:108 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1159
Practice Address - Country:US
Practice Address - Phone:517-552-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302410151OtherLICENSE NUMBER FOR THE STATE OF MICHIGAN