Provider Demographics
NPI:1447611439
Name:ZUCH, MARIELLA
Entity Type:Individual
Prefix:MRS
First Name:MARIELLA
Middle Name:
Last Name:ZUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1546
Mailing Address - Country:US
Mailing Address - Phone:717-285-7443
Mailing Address - Fax:
Practice Address - Street 1:2 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1546
Practice Address - Country:US
Practice Address - Phone:717-285-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042008R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist