Active NPI
Marilyn B Ekstam, RPH
- Pharmacist
- Rolla, MO
National Provider Identifier
1447430251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2007004488
- Practice address
- 708A N Pine St
Rolla, MO 65401-3138 - Phone
- (573) 422-6400
- Fax
- (573) 422-6403
- NPI assigned
- Nov 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2007004488 | MO | Primary |
Addresses
Primary practice location
708A N Pine St
Rolla, MO 65401-3138
Mailing address
606 Hwy 63 S
PO Box 606
Vienna, MO 65582
Phone (573) 422-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007004488 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194480000000",
"number": "1447430251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "606 HWY 63 S",
"address_2": "PO BOX 606",
"city": "VIENNA",
"state": "MO",
"postal_code": "65582",
"telephone_number": "573-422-6400",
"fax_number": "573-422-6403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "708A N PINE ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013138",
"telephone_number": "573-422-6400",
"fax_number": "573-422-6403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EKSTAM",
"first_name": "MARILYN",
"middle_name": "B",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-08",
"last_updated": "2007-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2007004488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.