Provider Demographics
NPI:1801887419
Name:MARASCO, RICHARD A (PHARM, FASCP, CGP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MARASCO
Suffix:
Gender:M
Credentials:PHARM, FASCP, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3982 KINDERLOU FOREST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:229-977-0275
Mailing Address - Fax:610-822-7340
Practice Address - Street 1:3982 KINDERLOU FOREST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:229-977-0275
Practice Address - Fax:610-822-7340
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0156131835P1200X
FLPS344811835P1200X
FLPU51911835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy