Provider Demographics
NPI:1851373849
Name:MARCILLA, JAMES JAVIER (PHARMD, PHC, RPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JAVIER
Last Name:MARCILLA
Suffix:
Gender:M
Credentials:PHARMD, PHC, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5049
Mailing Address - Country:US
Mailing Address - Phone:505-627-6915
Mailing Address - Fax:
Practice Address - Street 1:1204 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5049
Practice Address - Country:US
Practice Address - Phone:505-317-5783
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006782183500000X, 1835P1200X
NMRP00067821835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy