Provider Demographics
NPI:1255666509
Name:MARCHISELLO, DONNA W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:W
Last Name:MARCHISELLO
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 1:424 N BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4674
Mailing Address - Country:US
Mailing Address - Phone:919-989-4089
Mailing Address - Fax:
Practice Address - Street 1:424 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4674
Practice Address - Country:US
Practice Address - Phone:919-989-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist