Provider Demographics
NPI:1427314483
Name:ANDERSON-LABEAU, MARILYN LOIS (PHARMD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:LOIS
Last Name:ANDERSON-LABEAU
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 1:1205 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2271
Mailing Address - Country:US
Mailing Address - Phone:541-523-6743
Mailing Address - Fax:
Practice Address - Street 1:1205 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2271
Practice Address - Country:US
Practice Address - Phone:541-523-6743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist