Provider Demographics
NPI:1093094104
Name:MARSELLA, KELLY MARGARET (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARGARET
Last Name:MARSELLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-0269
Mailing Address - Country:US
Mailing Address - Phone:401-539-6001
Mailing Address - Fax:401-539-1314
Practice Address - Street 1:21 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:RI
Practice Address - Zip Code:02898-1101
Practice Address - Country:US
Practice Address - Phone:401-539-6001
Practice Address - Fax:401-539-1314
Is Sole Proprietor?:No
Enumeration Date:2011-08-06
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist