MEDICARE: VINCENT MARZO

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	RP451801	PA

General Provider Information

NPI Number	:	1790387611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT MARZO

Provider Business Mailing Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-1621
Country	:	US
Telephone Number	:	814-274-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-1621
Country	:	US
Telephone Number	:	814-274-8660
Fax Number	:

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “ VINCENT MARZO ” Practice Location

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