MEDICARE: MRS. MARLA LEE IRVIN R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03114773	OH

General Provider Information

NPI Number	:	1528274883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLA LEE IRVIN R.PH.

Provider Business Mailing Address
First Line	:	9469 CONKLIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-6725
Country	:	US
Telephone Number	:	513-791-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	10828 KENWOOD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-2812
Country	:	US
Telephone Number	:	513-792-7080
Fax Number	:	513-792-3838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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