Provider Demographics
NPI:1043007610
Name:PATHROSE, MARVIN THOMAS (PHARMD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:THOMAS
Last Name:PATHROSE
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E LEAMY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3020
Mailing Address - Country:US
Mailing Address - Phone:484-832-3572
Mailing Address - Fax:
Practice Address - Street 1:3930 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3209
Practice Address - Country:US
Practice Address - Phone:610-353-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist