Provider Demographics
NPI:1801178967
Name:MARCELLO, MEGHAN CLARE
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:CLARE
Last Name:MARCELLO
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 1:215 ABBY RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6018
Mailing Address - Country:US
Mailing Address - Phone:985-665-3980
Mailing Address - Fax:
Practice Address - Street 1:2910 E MILTON AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5379
Practice Address - Country:US
Practice Address - Phone:337-856-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist