MEDICARE: RICHARD A MARASCO PHARM., FASCP, CGP

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	1835P1200X	Pharmacotherapy Pharmacist	RPH015613	GA
2	1835P1200X	Pharmacotherapy Pharmacist	PS34481	FL
3	1835P1200X	Pharmacotherapy Pharmacist	PU5191	FL

General Provider Information

NPI Number	:	1801887419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A MARASCO PHARM., FASCP, CGP

Provider Business Mailing Address
First Line	:	3982 KINDERLOU FOREST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601
Country	:	US
Telephone Number	:	229-977-0275
Fax Number	:	610-822-7340

Provider Business Practice Location Address
First Line	:	3982 KINDERLOU FOREST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601
Country	:	US
Telephone Number	:	229-977-0275
Fax Number	:	610-822-7340

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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