Provider Demographics
NPI:1821699265
Name:WITKIN, MARISA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:WITKIN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WONDER VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3752
Mailing Address - Country:US
Mailing Address - Phone:301-646-6059
Mailing Address - Fax:
Practice Address - Street 1:18140 VILLAGE MART DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1413
Practice Address - Country:US
Practice Address - Phone:301-774-6304
Practice Address - Fax:844-411-6240
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist