Provider Demographics
NPI:1891825907
Name:MARCELLA, LEONARD WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:WAYNE
Last Name:MARCELLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:CHRIESMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77838-0063
Mailing Address - Country:US
Mailing Address - Phone:979-567-0673
Mailing Address - Fax:
Practice Address - Street 1:1111 EARL RUDDER FREEWAY
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840
Practice Address - Country:US
Practice Address - Phone:979-691-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist