Provider Demographics
NPI:1982927588
Name:MARCHESE, MARISA (RPH)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4605
Mailing Address - Country:US
Mailing Address - Phone:585-381-1305
Mailing Address - Fax:585-586-7829
Practice Address - Street 1:3195 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4605
Practice Address - Country:US
Practice Address - Phone:585-381-1305
Practice Address - Fax:585-586-7829
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036302OtherPHARMACIST LICENSE #