MEDICARE: DR. SAMUEL IAN MARSHALL 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	341398-1701	UT

General Provider Information

NPI Number	:	1528025475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL IAN MARSHALL PHARMD

Provider Business Mailing Address
First Line	:	639 LEGACY PARK AVE
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-1870
Country	:	US
Telephone Number	:	435-586-8293
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 E CENTER ST
Second Line	:
City	:	PANGUITCH
State	:	UT
Zip	:	84759-7703
Country	:	US
Telephone Number	:	435-676-2212
Fax Number	:	435-676-8850

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	04/06/2022

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