Provider Demographics
NPI:1922667732
Name:MARUSSICH, ROBERT JAMES (BSPHARMACY)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:MARUSSICH
Suffix:
Gender:M
Credentials:BSPHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5020
Mailing Address - Country:US
Mailing Address - Phone:203-733-1236
Mailing Address - Fax:
Practice Address - Street 1:77 LAFAYETTE PL STE 200
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5426
Practice Address - Country:US
Practice Address - Phone:203-863-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT90821835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology