Provider Demographics
NPI:1013734458
Name:MARRS, MORGANNE KATHLEEN
Entity type:Individual
Prefix:
First Name:MORGANNE
Middle Name:KATHLEEN
Last Name:MARRS
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 1:199 PHEASANT HILLS CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9293
Mailing Address - Country:US
Mailing Address - Phone:219-510-7121
Mailing Address - Fax:
Practice Address - Street 1:10 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5550
Practice Address - Country:US
Practice Address - Phone:219-769-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030813A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist