Provider Demographics
NPI:1962814368
Name:SOUZA, MARVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:
Last Name:SOUZA
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 1:3550 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0691
Mailing Address - Country:US
Mailing Address - Phone:209-722-3853
Mailing Address - Fax:
Practice Address - Street 1:3550 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0691
Practice Address - Country:US
Practice Address - Phone:209-722-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist