MEDICARE: MARCUS JULIAN IVORY 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	RPH032300	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH032300	OTHER	GA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1427658814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS JULIAN IVORY PHARMD

Provider Business Mailing Address
First Line	:	11201 REFLECTION WAY
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31407-0432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 OGEECHEE RD
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-9503
Country	:	US
Telephone Number	:	912-235-3425
Fax Number	:

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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