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General NPI Number Information
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NPI Number | 1336592096
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Entity Type | Individual
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Provider Name | ANDREA MARSHALL
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Gender | Female
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 3728 N PRINCE ST
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City | CLOVIS
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State | NM
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Zip | 88101-9744
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Country | US
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Telephone | 575-769-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 3728 N PRINCE ST
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City | CLOVIS
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State | NM
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Zip | 88101-9744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP00007636
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051291212
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH.03329307-3
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS54787
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License Number State | FL
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