Provider Demographics
NPI:1104194877
Name:MARRERO, ANGEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:
Last Name:MARRERO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PONTOOSIC RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4600
Mailing Address - Country:US
Mailing Address - Phone:413-231-7812
Mailing Address - Fax:
Practice Address - Street 1:100 PONTOOSIC RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4600
Practice Address - Country:US
Practice Address - Phone:413-231-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist