Provider Demographics
NPI:1124504220
Name:MARYANSKY, KARA L
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:L
Last Name:MARYANSKY
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 1:1431 W INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2501
Mailing Address - Country:US
Mailing Address - Phone:800-633-3977
Mailing Address - Fax:800-615-0075
Practice Address - Street 1:1431 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2501
Practice Address - Country:US
Practice Address - Phone:800-633-3977
Practice Address - Fax:800-615-0075
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41756183500000X
VA0202216648183500000X
NC18312183500000X
SC37626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC37626OtherLICENSE NO.
VA0202216648OtherLICENSE NO.
TN41756OtherLICENSE NO.
192827OtherNABP
NC18312OtherLICENSE NO.