Provider Demographics
NPI:1669794392
Name:MARZLOCK, CHRISTINE M
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MARZLOCK
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 1:7 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1581
Mailing Address - Country:US
Mailing Address - Phone:516-922-1443
Mailing Address - Fax:516-922-6436
Practice Address - Street 1:151 PINE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-4705
Practice Address - Country:US
Practice Address - Phone:516-922-1443
Practice Address - Fax:516-922-6436
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist