Provider Demographics
NPI:1649583444
Name:MAZMANIAN, MARY KRISTINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KRISTINE
Last Name:MAZMANIAN
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 1:43 MCCOMBE DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-9705
Mailing Address - Country:US
Mailing Address - Phone:518-439-3923
Mailing Address - Fax:
Practice Address - Street 1:43 MCCOMBE DR
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-9705
Practice Address - Country:US
Practice Address - Phone:518-439-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051100-1183500000X
MA24800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist