Basic Information
Provider Information
NPI: 1740482868
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHWARTZ
FirstName: MARLA
MiddleName: ELAINE BLUM
NamePrefix: MRS.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 33 REDWOOD DR
Address2:  
City: RICHBORO
State: PA
PostalCode: 189541633
CountryCode: US
TelephoneNumber: 2158606805
FaxNumber:  
Practice Location
Address1: 1601 CHERRY ST
Address2: SUITE 1700
City: PHILA
State: PA
PostalCode: 191021321
CountryCode: US
TelephoneNumber: 2152821600
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XRP039493LPAY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home