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NPI Code Detail

MEDICARE: MARK MARQUEZ R.PH.

MEDICARE: MARK MARQUEZ 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
1183500000XPharmacistOH

General Provider Information

NPI Number : 1558346726
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK MARQUEZ R.PH.
Provider Business Mailing Address
First Line : 100 DAWN LN
Second Line :
City : WAVERLY
State : OH
Zip : 45690-9138
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 DAWN LN
Second Line :
City : WAVERLY
State : OH
Zip : 45690-9138
Country : US
Telephone Number : 740-947-6377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2005
Last Update Date : 07/08/2007

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