Provider Demographics
NPI:1710293253
Name:MARZIALE, PHILIP ANTHONY SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:MARZIALE
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-3625
Mailing Address - Country:US
Mailing Address - Phone:609-693-7021
Mailing Address - Fax:609-693-5749
Practice Address - Street 1:138 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-3625
Practice Address - Country:US
Practice Address - Phone:609-693-7021
Practice Address - Fax:609-693-5749
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01310400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist