Provider Demographics
NPI:1326366881
Name:MARSELLA, LISA BETH (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETH
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 1:58 ANAWAN RD
Mailing Address - Street 2:
Mailing Address - City:N ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2152
Mailing Address - Country:US
Mailing Address - Phone:774-643-6059
Mailing Address - Fax:
Practice Address - Street 1:1123 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5406
Practice Address - Country:US
Practice Address - Phone:508-588-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226431835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric