Provider Demographics
NPI:1962196451
Name:MARZILLI, VINCENT JR (RPH)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:MARZILLI
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 NORWICH NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1917
Mailing Address - Country:US
Mailing Address - Phone:860-848-0865
Mailing Address - Fax:
Practice Address - Street 1:887 NORWICH NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1917
Practice Address - Country:US
Practice Address - Phone:860-848-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMMDR.0000309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty