MEDICARE: DR. DAVID A MARLEY 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	12343	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12343	OTHER	NC	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1588674337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A MARLEY PHARM D

Provider Business Mailing Address
First Line	:	2255 WALDENSHIRE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127
Country	:	US
Telephone Number	:	336-785-4966
Fax Number	:	336-771-9921

Provider Business Practice Location Address
First Line	:	5030 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127
Country	:	US
Telephone Number	:	336-771-7672
Fax Number	:	336-771-9921

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID A MARLEY PHARM D” Practice Location

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