Provider Demographics
NPI:1194969477
Name:JUHASZ, MARNI FERTIG (PHARMD)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:FERTIG
Last Name:JUHASZ
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 1:5397 HEATHER GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6212
Mailing Address - Country:US
Mailing Address - Phone:919-434-1004
Mailing Address - Fax:563-324-3305
Practice Address - Street 1:2151 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3628
Practice Address - Country:US
Practice Address - Phone:563-324-5004
Practice Address - Fax:563-324-3305
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist