Healthcare Provider Details

I. General information

NPI: 1659299626
Provider Name (Legal Business Name): DEKLAN PAUL MARSHALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 US HIGHWAY 41 W
ISHPEMING MI
49849-3152
US

IV. Provider business mailing address

1330 US HIGHWAY 41 W
ISHPEMING MI
49849-3152
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-5592
  • Fax: 906-485-4482
Mailing address:
  • Phone: 906-485-5592
  • Fax: 906-485-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: