Provider Demographics
NPI:1780370387
Name:DREEZE, MARCELINA M
Entity type:Individual
Prefix:
First Name:MARCELINA
Middle Name:M
Last Name:DREEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DREEZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1110 MALCOLM RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6822
Mailing Address - Country:US
Mailing Address - Phone:419-265-8652
Mailing Address - Fax:419-536-7571
Practice Address - Street 1:1605 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-3239
Practice Address - Country:US
Practice Address - Phone:419-244-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09200859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist