Provider Demographics
NPI:1457056061
Name:MARCELIN, HARRY P (PHARMD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:P
Last Name:MARCELIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5721
Mailing Address - Country:US
Mailing Address - Phone:954-486-7101
Mailing Address - Fax:
Practice Address - Street 1:4010 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5721
Practice Address - Country:US
Practice Address - Phone:954-486-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47012183500000X
NC19627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist