Provider Demographics
NPI:1326162876
Name:BERNARDUCCI, MARC P (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:P
Last Name:BERNARDUCCI
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 COURTYARD LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1393
Mailing Address - Country:US
Mailing Address - Phone:757-289-1189
Mailing Address - Fax:973-270-2466
Practice Address - Street 1:897 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7203
Practice Address - Country:US
Practice Address - Phone:757-368-3273
Practice Address - Fax:757-368-2960
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2727OtherPHARMACY LICENSE
RI3581OtherPHARMACY LICENSE
VA0202011922OtherPHARMACY LICENSE
ME4329OtherPHARMACY LICENSE