Provider Demographics
NPI:1891078325
Name:GUASTELLA, MARLA FRANCES (RPH BS)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:FRANCES
Last Name:GUASTELLA
Suffix:
Gender:F
Credentials:RPH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2324
Mailing Address - Country:US
Mailing Address - Phone:216-525-0732
Mailing Address - Fax:216-525-0736
Practice Address - Street 1:6900 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2324
Practice Address - Country:US
Practice Address - Phone:216-525-0732
Practice Address - Fax:216-525-0736
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03327045183500000X
IN26015758A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist