MEDICARE: DR. KATHLEEN MARSHALL PHARM.D.

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	PS36626	FL

General Provider Information

NPI Number	:	1497941165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MARSHALL PHARM.D.

Provider Business Mailing Address
First Line	:	7729 SW US HWY 27
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038
Country	:	US
Telephone Number	:	386-497-2580
Fax Number	:	386-497-4227

Provider Business Practice Location Address
First Line	:	7729 SW US HWY 27
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038
Country	:	US
Telephone Number	:	386-497-2580
Fax Number	:	386-497-4227

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/17/2007

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