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General NPI Number Information
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NPI Number | 1972077410
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Entity Type | Individual
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Provider Name | MS. SOMER ALEXANDRIA MARSHALL
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Gender | Female
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 610 EGLIN PKWY NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-2832
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Country | US
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Telephone | 334-318-9872
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Fax |
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Provider Business Mailing Address
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Address Line | 251 YACHT CLUB DR
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City | NICEVILLE
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State | FL
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Zip | 32578-3720
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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 | 63070
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | S12325
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License Number State | AL
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