Provider Demographics
NPI:1477622769
Name:MAZER, MARVIN ALLEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:ALLEN
Last Name:MAZER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 KISMET RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1114
Mailing Address - Country:US
Mailing Address - Phone:215-698-7858
Mailing Address - Fax:
Practice Address - Street 1:206 WELSH RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2208
Practice Address - Country:US
Practice Address - Phone:215-706-5100
Practice Address - Fax:800-228-6716
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025421L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist