Provider Demographics
NPI:1457673667
Name:MARIANO, ARTHUR SURLA (RPH)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:SURLA
Last Name:MARIANO
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 1:255 FARENHOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3209
Mailing Address - Country:US
Mailing Address - Phone:671-646-5355
Mailing Address - Fax:671-646-5333
Practice Address - Street 1:255 FARENHOLT AVE
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3209
Practice Address - Country:US
Practice Address - Phone:671-646-5355
Practice Address - Fax:671-646-5333
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH-076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist