Provider Demographics
NPI:1366125601
Name:MEYERS, MARYANNE TERESA
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:TERESA
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19405-1516
Mailing Address - Country:US
Mailing Address - Phone:215-713-4596
Mailing Address - Fax:
Practice Address - Street 1:3811 NESHAMINY BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1650
Practice Address - Country:US
Practice Address - Phone:215-396-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist