Provider Demographics
NPI:1588879563
Name:MACMILLAN, MARISA QUARANTA (RPH)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:QUARANTA
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3410
Mailing Address - Country:US
Mailing Address - Phone:206-932-4225
Mailing Address - Fax:206-938-3454
Practice Address - Street 1:4707 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4412
Practice Address - Country:US
Practice Address - Phone:206-932-4225
Practice Address - Fax:206-938-3454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist