=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205099116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GORDON H MARRS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2008
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15950 S. RANCHO SAHUARITA BLVD
-----------------------------------------------------
City | SAHUARITA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-648-7701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15950 S. RANCHO SAHUARITA BLVD
-----------------------------------------------------
City | SAHUARITA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8061
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------