Provider Demographics
NPI:1548810674
Name:WYATT, MARIELA ISABEL (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:ISABEL
Last Name:WYATT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARIELA
Other - Middle Name:ISABEL
Other - Last Name:CALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20713 CRYSTAL HILL CIR APT J
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3935
Mailing Address - Country:US
Mailing Address - Phone:202-344-7366
Mailing Address - Fax:
Practice Address - Street 1:301 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6415
Practice Address - Country:US
Practice Address - Phone:410-620-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist