Provider Demographics
NPI:1750989661
Name:MARCELIN, JESSICA (PHARM D)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARCELIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 BRIDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7008
Mailing Address - Country:US
Mailing Address - Phone:404-432-2383
Mailing Address - Fax:
Practice Address - Street 1:9110 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3522
Practice Address - Country:US
Practice Address - Phone:410-496-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD27011OtherMARYLAND BOARD OF PHARMACY