Provider Demographics
NPI:1043009848
Name:MARZO, JOHARA MAE
Entity type:Individual
Prefix:
First Name:JOHARA MAE
Middle Name:
Last Name:MARZO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 AMSTERDAM AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6327
Mailing Address - Country:US
Mailing Address - Phone:252-292-8798
Mailing Address - Fax:
Practice Address - Street 1:5 PENN PLZ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1863
Practice Address - Country:US
Practice Address - Phone:212-216-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist