Individual
MISS MARIETTE SOURIAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
301 HIGHWAY 65 S, MORA, MN 55051-1899
(320) 225-3597
Mailing address
109 MAPLE AVE E APT 2, MORA, MN 55051-1309
(518) 894-8564
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120221
MN
1835P1200X
Pharmacotherapy Pharmacist
120221
MN
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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