Provider Demographics
NPI:1578855003
Name:MARRIOTT, MARY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 N MERCER AVE
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-2234
Mailing Address - Country:US
Mailing Address - Phone:724-962-5771
Mailing Address - Fax:724-962-2040
Practice Address - Street 1:64 N MERCER AVE
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-2234
Practice Address - Country:US
Practice Address - Phone:724-962-5771
Practice Address - Fax:724-962-2040
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038757L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP038757LOtherPHARMACY SERVICE PROVIDER