Provider Demographics
NPI:1730461625
Name:MARCELO, EILEEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MARCELO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 FLYFISHER CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1500
Mailing Address - Country:US
Mailing Address - Phone:757-965-4655
Mailing Address - Fax:
Practice Address - Street 1:3364 PRINCESS ANNE RD STE 501
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2610
Practice Address - Country:US
Practice Address - Phone:757-468-5879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist