Provider Demographics
NPI:1760088603
Name:CASALE, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CASALE
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 1:2 MARSTON RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9421
Mailing Address - Country:US
Mailing Address - Phone:973-252-6122
Mailing Address - Fax:
Practice Address - Street 1:281 STATE ROUTE 10 E
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1378
Practice Address - Country:US
Practice Address - Phone:973-584-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02415700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist