Provider Demographics
NPI:1265791370
Name:KOLESNIKOVA, MARINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:KOLESNIKOVA
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 1:9002 LINCOLN DR W STE C
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3204
Mailing Address - Country:US
Mailing Address - Phone:856-596-3939
Mailing Address - Fax:856-596-3959
Practice Address - Street 1:9002 LINCOLN DR W STE C
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3204
Practice Address - Country:US
Practice Address - Phone:856-596-3939
Practice Address - Fax:856-596-3959
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02368300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist