Healthcare Provider Details

I. General information

NPI: 1982786331
Provider Name (Legal Business Name): JOHN DAVID MARSH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 LAUREL ST 2ND FLOOR
COLUMBIA SC
29201-2514
US

IV. Provider business mailing address

1308 LAUREL ST 2ND FLOOR
COLUMBIA SC
29201-2514
US

V. Phone/Fax

Practice location:
  • Phone: 803-931-8124
  • Fax: 803-931-8201
Mailing address:
  • Phone: 803-931-8124
  • Fax: 803-931-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number8127
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: