Healthcare Provider Details

I. General information

NPI: 1447662143
Provider Name (Legal Business Name): MARLIN BLANE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 DONELSON PKWY
DOVER TN
37058-3724
US

IV. Provider business mailing address

1307 DONELSON PKWY
DOVER TN
37058-3724
US

V. Phone/Fax

Practice location:
  • Phone: 931-232-0123
  • Fax: 931-232-1185
Mailing address:
  • Phone: 931-232-0123
  • Fax: 931-232-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7965
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: