Provider Demographics
NPI:1609996610
Name:NASH-YAZBECK, MARILYN TRYPHENA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:TRYPHENA
Last Name:NASH-YAZBECK
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 1:5039 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2039
Mailing Address - Country:US
Mailing Address - Phone:313-894-1004
Mailing Address - Fax:313-897-4835
Practice Address - Street 1:15800 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3218
Practice Address - Country:US
Practice Address - Phone:313-885-3363
Practice Address - Fax:313-885-3357
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist