Provider Demographics
NPI:1558485326
Name:GUZZARDO, MARC L (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:L
Last Name:GUZZARDO
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 1:6615 CHIRCO CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3415
Mailing Address - Country:US
Mailing Address - Phone:586-206-2419
Mailing Address - Fax:
Practice Address - Street 1:6615 CHIRCO CT
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3415
Practice Address - Country:US
Practice Address - Phone:586-206-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020256991835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric