Provider Demographics
NPI:1790268985
Name:MARZELLA, REGINA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:MARZELLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:SOSNICKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2425 JODI CT
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1132
Mailing Address - Country:US
Mailing Address - Phone:908-489-0057
Mailing Address - Fax:
Practice Address - Street 1:347E MATAWAN RD
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3926
Practice Address - Country:US
Practice Address - Phone:732-970-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02136300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist