Provider Demographics
NPI:1912291881
Name:LETARGO-ENRIQUEZ, MARIANE
Entity type:Individual
Prefix:
First Name:MARIANE
Middle Name:
Last Name:LETARGO-ENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIANE
Other - Middle Name:
Other - Last Name:LETARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:742 AVON FIELDS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1511
Mailing Address - Country:US
Mailing Address - Phone:513-549-4746
Mailing Address - Fax:513-549-4746
Practice Address - Street 1:9841 WATERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-8296
Practice Address - Country:US
Practice Address - Phone:513-677-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-24536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist