Healthcare Provider Details

I. General information

NPI: 1467440149
Provider Name (Legal Business Name): MARSHALL'S DRUG STORE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CROSS ST
URBANNA VA
23175-0310
US

IV. Provider business mailing address

PO BOX 310
URBANNA VA
23175-0310
US

V. Phone/Fax

Practice location:
  • Phone: 804-758-5344
  • Fax: 804-758-3366
Mailing address:
  • Phone: 804-758-5344
  • Fax: 804-758-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201000441
License Number StateVA

VIII. Authorized Official

Name: MRS. REBECCA MARSHALL EDWARDS
Title or Position: PRESIDENT/PHARMACIST
Credential: RPH
Phone: 804-758-5344