Provider Demographics
NPI:1578671913
Name:SHUKHAT, MARINA J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:J
Last Name:SHUKHAT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAPLE ST APT G
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2974
Mailing Address - Country:US
Mailing Address - Phone:857-203-5460
Mailing Address - Fax:857-203-5771
Practice Address - Street 1:61 MAPLE ST
Practice Address - Street 2:APT G
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2974
Practice Address - Country:US
Practice Address - Phone:857-203-5460
Practice Address - Fax:857-203-5771
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist