MEDICARE: EILEEN MARCELO PHARM D

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	0202207152	VA

General Provider Information

NPI Number	:	1730461625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MARCELO PHARM D

Provider Business Mailing Address
First Line	:	1433 FLYFISHER CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1500
Country	:	US
Telephone Number	:	757-965-4655
Fax Number	:

Provider Business Practice Location Address
First Line	:	3364 PRINCESS ANNE RD STE 501
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2610
Country	:	US
Telephone Number	:	757-468-5879
Fax Number	:

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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