Individual
MARILYN B EKSTAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
708A N PINE ST, ROLLA, MO 65401-3138
(573) 422-6400
(573) 422-6403
Mailing address
606 HWY 63 S, PO BOX 606, VIENNA, MO 65582
(573) 422-6400
(573) 422-6403
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2007004488
MO
Other
Enumeration date
11/08/2007
Last updated
11/08/2007
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