Provider Demographics
NPI:1376753863
Name:GUARDIA, MARIE NELLIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:NELLIE
Last Name:GUARDIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:T14 CALLE MCKINLEY
Mailing Address - Street 2:PARKVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3913
Mailing Address - Country:US
Mailing Address - Phone:787-789-4716
Mailing Address - Fax:
Practice Address - Street 1:ROAD #24
Practice Address - Street 2:REXCO INDUSTRIAL PARK
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-792-2707
Practice Address - Fax:787-792-4903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33311835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support