Healthcare Provider Details

I. General information

NPI: 1265023600
Provider Name (Legal Business Name): MARLENE OCHABILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 N 5TH ST
PHILADELPHIA PA
19120-1423
US

IV. Provider business mailing address

6150 N 5TH ST
PHILADELPHIA PA
19120-1423
US

V. Phone/Fax

Practice location:
  • Phone: 215-548-1110
  • Fax: 215-224-1100
Mailing address:
  • Phone: 215-548-1110
  • Fax: 215-224-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP-040148L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: