Dr. Marisa Kay Goninen, PharmD
Pharmacist, Ambulatory Care in Elm Grove, WI. Individual provider (NPI-1).
NPI number1164047684
StatusActive
Last updated in NPPESOct 23, 2020
Details
- NPI
- 1164047684
- Entity type
- Individual (NPI-1)
- Name
- Dr. Marisa Kay Goninen
- Credential
- PharmD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 10, 2020
- Certification date
- Oct 23, 2020
- Last updated
- Oct 23, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1835P2201X | Pharmacist, Ambulatory Care | 18402-40 | WI | Yes |
| 1835P2201X | Pharmacist, Ambulatory Care | 051302431 | IL |
Other names
- Marisa Kay Frey (Former Name)
Practice location
12500 W Bluemound RdElm Grove, WI 53122-2600
Phone 262-957-8239
Mailing address
12500 W Bluemound RdElm Grove, WI 53122-2600
Phone 262-957-8239
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