Provider Demographics
NPI:1386124394
Name:SCUMACI, MARISSA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:SCUMACI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W KINGSTON AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6442
Mailing Address - Country:US
Mailing Address - Phone:585-478-2204
Mailing Address - Fax:
Practice Address - Street 1:1500 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3487
Practice Address - Country:US
Practice Address - Phone:704-526-4651
Practice Address - Fax:704-526-4653
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist