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General NPI Number Information
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NPI Number | 1427110543
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Entity Type | Individual
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Provider Name | MARY BETH MARANDOLA-KENVIN RPH
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FERRY RD NE NORTHSIDE HOSPITAL
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 404-851-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 970 WARTER GROVE COURT
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City | ROSWELL
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State | GA
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Zip | 30075
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28R101696700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH018655
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License Number State | GA
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