Provider Demographics
NPI:1902214968
Name:GUZDA, MARIETTA MARIA
Entity Type:Individual
Prefix:MISS
First Name:MARIETTA
Middle Name:MARIA
Last Name:GUZDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3609
Mailing Address - Country:US
Mailing Address - Phone:315-339-5290
Mailing Address - Fax:
Practice Address - Street 1:1616 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3609
Practice Address - Country:US
Practice Address - Phone:315-339-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0159411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist