Provider Demographics
NPI:1730227877
Name:FELLERHOFF, MARLA (RPH, PHC)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:
Last Name:FELLERHOFF
Suffix:
Gender:F
Credentials:RPH, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CAMINO DE LA SIERRA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5602
Mailing Address - Country:US
Mailing Address - Phone:505-298-4063
Mailing Address - Fax:
Practice Address - Street 1:8800 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2310
Practice Address - Country:US
Practice Address - Phone:505-462-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM5253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist