Provider Demographics
NPI:1154615417
Name:DENNISON, MARION KATHRIN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARION KATHRIN
Middle Name:
Last Name:DENNISON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 S WEBER RD
Mailing Address - Street 2:T-2293
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-6530
Mailing Address - Country:US
Mailing Address - Phone:815-524-9802
Mailing Address - Fax:815-524-9812
Practice Address - Street 1:349 S WEBER RD
Practice Address - Street 2:T-2293
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6530
Practice Address - Country:US
Practice Address - Phone:815-524-9802
Practice Address - Fax:815-524-9812
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist