Healthcare Provider Details

I. General information

NPI: 1811599418
Provider Name (Legal Business Name): DAVID WILLIAM MARCUM PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
MARION IL
62959-1188
US

IV. Provider business mailing address

6854 RIVER RD
IUKA IL
62849-2316
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax: 618-993-4188
Mailing address:
  • Phone: 618-780-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: