MEDICARE: MARC GARRETT

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	11808	KS

General Provider Information

NPI Number	:	1548660418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC GARRETT

Provider Business Mailing Address
First Line	:	13415 W MAPLE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-8729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13415 W MAPLE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-8729
Country	:	US
Telephone Number	:	316-729-5204
Fax Number	:

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

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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