Provider Demographics
NPI:1063759934
Name:MARZANO, ADRIENNE SUSAN (RPH)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:SUSAN
Last Name:MARZANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 SPOUT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5543
Mailing Address - Country:US
Mailing Address - Phone:770-967-4103
Mailing Address - Fax:
Practice Address - Street 1:7334 SPOUT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5543
Practice Address - Country:US
Practice Address - Phone:770-967-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist