Provider Demographics
NPI:1306920566
Name:YURCHICK, MARILYN JEAN (RPH)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
Last Name:YURCHICK
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 1:13 VANBUREN STREET
Mailing Address - Street 2:PO BOX 242
Mailing Address - City:COKEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 INDEPENDENCE STREET
Practice Address - Street 2:BOX 314
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473
Practice Address - Country:US
Practice Address - Phone:724-736-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028239L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP028239LOtherPHARMACY LICENSE NUMBER