Provider Demographics
NPI:1902521669
Name:ARUNAKUL, MARISA ANN
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:ARUNAKUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3894
Mailing Address - Country:US
Mailing Address - Phone:573-556-5615
Mailing Address - Fax:573-556-8749
Practice Address - Street 1:900 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3894
Practice Address - Country:US
Practice Address - Phone:573-556-5615
Practice Address - Fax:573-556-8749
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022036485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist