Provider Demographics
NPI:1053602854
Name:IMBRIANO, MARINA (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:IMBRIANO
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570
Mailing Address - Country:US
Mailing Address - Phone:508-943-5146
Mailing Address - Fax:508-943-5425
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1701
Practice Address - Country:US
Practice Address - Phone:508-943-5146
Practice Address - Fax:508-943-5425
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist