Provider Demographics
NPI:1235000118
Name:AWADALLA, MARIAN G
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:G
Last Name:AWADALLA
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 1:7660 S CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8252
Mailing Address - Country:US
Mailing Address - Phone:414-762-9653
Mailing Address - Fax:
Practice Address - Street 1:7660 S CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8252
Practice Address - Country:US
Practice Address - Phone:414-762-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13581-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist