Marisa Kay Goninen, PHARMD

Primary specialty

Ambulatory Care PharmacistTaxonomy code 1835P2201X

License

18402-40 Issued in WI

Practice address

12500 W Bluemound Rd
Elm Grove, WI 53122-2600

Phone

(262) 957-8239

NPI assigned

Jun 10, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Marisa Kay Frey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1164047684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12500 W BLUEMOUND RD",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222600",
            "telephone_number": "262-957-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12500 W BLUEMOUND RD",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222600",
            "telephone_number": "262-957-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONINEN",
        "first_name": "MARISA",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "IL",
            "license": "051302431",
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "WI",
            "license": "18402-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "FREY",
            "middle_name": "KAY",
            "prefix": "DR.",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elisabeth Gehrke, LPC
• Genesis Counseling Group, S.C.
• Timothy Raymond Gengembre, PA-C
• Scott Goehner, ATC
• Gail Golden, OTR
• Shelbie Lee Sullivan Gorman, NCC, LPC, PMH-C
• Greater Milwaukee Therapy Services LLC
• Gary R Gregg, PSY.D.
• Jamie L Greisinger, DPT
• Grey Matters Counseling LLC

• All providers in Elm Grove, WI
• Ambulatory Care Pharmacist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.