Provider Demographics
NPI:1063021657
Name:MARINES, THEODORE (PHARMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:MARINES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:MARINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8 MCCANDLESS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9381
Mailing Address - Country:US
Mailing Address - Phone:717-479-3632
Mailing Address - Fax:
Practice Address - Street 1:8 MCCANDLESS DR
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9381
Practice Address - Country:US
Practice Address - Phone:717-479-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist