MEDICARE: MARCUS FRANKLIN RPH

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	8087	KY

General Provider Information

NPI Number	:	1619090032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS FRANKLIN RPH

Provider Business Mailing Address
First Line	:	4428 SPURRIER RD
Second Line	:
City	:	BIG CLIFTY
State	:	KY
Zip	:	42712-6819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	IRELAND LOOP BLDG 851
Second Line	:	PHARMACY SERVICE
City	:	FT. KNOX
State	:	KY
Zip	:	40121
Country	:	US
Telephone Number	:	502-624-9036
Fax Number	:	502-624-9873

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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