Provider Demographics
NPI:1710671458
Name:MARCETTI, CORWIN
Entity Type:Individual
Prefix:
First Name:CORWIN
Middle Name:
Last Name:MARCETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 LAGAE ROAD
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9509
Mailing Address - Country:US
Mailing Address - Phone:720-214-2283
Mailing Address - Fax:720-214-2289
Practice Address - Street 1:7370 LAGAE RD
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9509
Practice Address - Country:US
Practice Address - Phone:720-214-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016828183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician