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NPI Code Detail

MEDICARE: MR. JON PATRICK MARSHALL RPH

MEDICARE: MR. JON PATRICK MARSHALL 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
1183500000XPharmacist051.286958IL

General Provider Information

NPI Number : 1639451420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JON PATRICK MARSHALL RPH
Provider Business Mailing Address
First Line : 4912 EDEN CT
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-9254
Country : US
Telephone Number : 217-553-1621
Fax Number :
Provider Business Practice Location Address
First Line : 2945 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-4024
Country : US
Telephone Number : 217-788-5846
Fax Number : 217-788-8128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2011
Last Update Date : 09/16/2011

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