Provider Demographics
NPI:1457587255
Name:RUSCZ, MARIANNE
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:RUSCZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 OLD BRICKYARD LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1423
Mailing Address - Country:US
Mailing Address - Phone:800-282-4321
Mailing Address - Fax:860-829-4111
Practice Address - Street 1:77 OLD BRICKYARD LN
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-1423
Practice Address - Country:US
Practice Address - Phone:800-282-4321
Practice Address - Fax:860-829-4111
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist