Provider Demographics
NPI:1487241931
Name:WURL, MARINA (RPH)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:WURL
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 1:221 HUTTLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1956
Mailing Address - Country:US
Mailing Address - Phone:508-990-4700
Mailing Address - Fax:508-990-0906
Practice Address - Street 1:221 HUTTLESTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-1956
Practice Address - Country:US
Practice Address - Phone:508-990-4700
Practice Address - Fax:508-990-0906
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist