Healthcare Provider Details

I. General information

NPI: 1962554410
Provider Name (Legal Business Name): BARRY ALEXANDER MARKS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MAIN ST
REYNOLDSVILLE PA
15851
US

IV. Provider business mailing address

PO BOX 57 419 MAIN ST
REYNOLDSVILLE PA
15851
US

V. Phone/Fax

Practice location:
  • Phone: 814-653-8295
  • Fax:
Mailing address:
  • Phone: 814-653-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP029561L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: