Organization
MARISSA FOOD MART
Active
Parent organization
MARISSA FOOD MART INC.
Other names
DBA Marissa Discount Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARISSA FOOD MART INC.
Authorized official
MRS. GAIL LASKOWSKI (SECRETARY OF CORP.)
(618) 295-2317
Entity
Organization
Contact information
Practice address
700 E. LYONS ST., MARISSA, IL 62257
(618) 295-2317
(618) 295-2318
Mailing address
700 E. LYONS ST., MARISSA, IL 62257
(618) 295-2317
(618) 295-2318
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054.009766
IL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054009766
LICENSE
IL
Enumeration date
11/20/2006
Last updated
04/15/2015
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