Provider Demographics
NPI:1760782262
Name:GARDIN, MARISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:GARDIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5154
Mailing Address - Country:US
Mailing Address - Phone:484-557-5293
Mailing Address - Fax:
Practice Address - Street 1:50 E WYNNEWOOD RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2013
Practice Address - Country:US
Practice Address - Phone:610-602-8015
Practice Address - Fax:610-602-8002
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist