Basic Information
| Provider Information | |||||||||
| NPI: | 1104454065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCOTTE | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14230 MAGOUN ST | ||||||||
| Address2: | |||||||||
| City: | CEDAR LAKE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463039353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089450318 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15900 W 101ST AVE | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463113065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193656333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2020 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 26022386A | IN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.