Provider Demographics
NPI:1548392921
Name:MARZILLI, LISA (RPH, PHARMD, CDOE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARZILLI
Suffix:
Gender:F
Credentials:RPH, PHARMD, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7228
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02887-7228
Mailing Address - Country:US
Mailing Address - Phone:401-480-2193
Mailing Address - Fax:
Practice Address - Street 1:1020 BALD HILL RD
Practice Address - Street 2:BROOKS PHARMACY
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0744
Practice Address - Country:US
Practice Address - Phone:401-480-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI33401835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy