Provider Demographics
NPI:1346562014
Name:ZAVACKY, MARC (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:ZAVACKY
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 1:2132 TARLETON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2957
Mailing Address - Country:US
Mailing Address - Phone:434-975-2574
Mailing Address - Fax:
Practice Address - Street 1:1801 HYDRAULIC RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2839
Practice Address - Country:US
Practice Address - Phone:434-295-5184
Practice Address - Fax:434-296-0573
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202008098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist