Provider Demographics
NPI:1689260622
Name:MARRONE, JAMIE ASHFORD
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ASHFORD
Last Name:MARRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1270
Mailing Address - Country:US
Mailing Address - Phone:508-829-7631
Mailing Address - Fax:508-829-7631
Practice Address - Street 1:160 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1270
Practice Address - Country:US
Practice Address - Phone:508-829-7631
Practice Address - Fax:508-829-0548
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist