Provider Demographics
NPI:1598013476
Name:PICCUTA, MARSHA LYNN
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LYNN
Last Name:PICCUTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:LYNN
Other - Last Name:WINELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:139 RIVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9257
Mailing Address - Country:US
Mailing Address - Phone:864-439-1040
Mailing Address - Fax:864-949-0461
Practice Address - Street 1:101 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1503
Practice Address - Country:US
Practice Address - Phone:864-439-1040
Practice Address - Fax:864-949-0461
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009334183500000X
PARP038548L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009334OtherSOUTH CAROLINA PHARMACIST LICENSE
PARP038548LOtherPENNSYLVAINIA PHARMACIST LICENSE