Provider Demographics
NPI:1922134980
Name:TRISKA, MARCIA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:TRISKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 FOX RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-8725
Mailing Address - Country:US
Mailing Address - Phone:419-884-1450
Mailing Address - Fax:
Practice Address - Street 1:140 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1833
Practice Address - Country:US
Practice Address - Phone:419-347-2033
Practice Address - Fax:419-347-2053
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-3-20165OtherSTATE LISENCE NUMBER