Healthcare Provider Details

I. General information

NPI: 1174775340
Provider Name (Legal Business Name): MARCELINE ANGELA FITZWILLIAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2008
Last Update Date: 10/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MARKET ST
PHILADELPHIA PA
19106-2312
US

IV. Provider business mailing address

6431 MORRIS PARK RD
PHILADELPHIA PA
19151-2404
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-6433
  • Fax: 215-627-6408
Mailing address:
  • Phone: 215-627-6433
  • Fax: 215-627-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438870
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: