Provider Demographics
NPI:1700963279
Name:MARRA, GEORGE A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:MARRA
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 1:769 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2952
Mailing Address - Country:US
Mailing Address - Phone:781-344-2311
Mailing Address - Fax:
Practice Address - Street 1:769 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2952
Practice Address - Country:US
Practice Address - Phone:781-344-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0436607Medicaid
MA0436607Medicaid