MEDICARE: CASEY N MARVEL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	A1-0003724	DE
2	183500000X	Pharmacist	19505	MD

General Provider Information

NPI Number	:	1255615647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY N MARVEL PHARMD

Provider Business Mailing Address
First Line	:	735 S SALISBURY BLVD
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5812
Country	:	US
Telephone Number	:	410-219-5261
Fax Number	:	410-219-5267

Provider Business Practice Location Address
First Line	:	735 S SALISBURY BLVD
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5812
Country	:	US
Telephone Number	:	410-219-5261
Fax Number	:	410-219-5267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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