MEDICARE: MRS. MARCELINE ANGELA FITZWILLIAM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP438870	PA

General Provider Information

NPI Number	:	1174775340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCELINE ANGELA FITZWILLIAM PHARMD

Provider Business Mailing Address
First Line	:	6431 MORRIS PARK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2404
Country	:	US
Telephone Number	:	215-627-6433
Fax Number	:	215-627-6406

Provider Business Practice Location Address
First Line	:	730 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-2312
Country	:	US
Telephone Number	:	215-627-6433
Fax Number	:	215-627-6408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2008
Last Update Date	:	10/18/2008

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