Provider Demographics
NPI:1982929451
Name:TREPANIER, MARLA JEANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JEANNE
Last Name:TREPANIER
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 1:1428 N POMERENE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-7908
Mailing Address - Country:US
Mailing Address - Phone:520-349-8058
Mailing Address - Fax:
Practice Address - Street 1:101 NACO RD
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-9655
Practice Address - Country:US
Practice Address - Phone:520-432-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS010726OtherAZ PHARMACY LICENSE