Provider Demographics
NPI:1851112973
Name:GUZMAN, MARIELA (RPH)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:GUZMAN
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 1:1610 UNIVERSITY AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6923
Mailing Address - Country:US
Mailing Address - Phone:347-425-5340
Mailing Address - Fax:
Practice Address - Street 1:300 W 135TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2731
Practice Address - Country:US
Practice Address - Phone:212-491-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist