MEDICARE: MARLEY DRUG INC

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	3336C0003X	Community/Retail Pharmacy	08320	NC
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2069685	OTHER		PK

General Provider Information

NPI Number	:	1376640201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLEY DRUG INC

Provider Business Mailing Address
First Line	:	5008 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7276
Country	:	US
Telephone Number	:	336-771-7672
Fax Number	:	336-771-9921

Provider Business Practice Location Address
First Line	:	5008 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7276
Country	:	US
Telephone Number	:	336-771-7672
Fax Number	:	336-771-9921

Authorized Official
Title or Position	:	OFFICER OF MARLEY DRUG AND CFO
Name	:	MR. JAMES KINLEY
Credential	:
Telephone Number	:	204-478-5604

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/19/2021

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Directions to “MARLEY DRUG INC ” Practice Location

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