Provider Demographics
NPI:1205266822
Name:FLORENCE, MARSHALL
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:FLORENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 FAIRFAX DR
Mailing Address - Street 2:PH 09
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1661
Mailing Address - Country:US
Mailing Address - Phone:412-527-0089
Mailing Address - Fax:
Practice Address - Street 1:3900 FAIRFAX DR
Practice Address - Street 2:PH 09
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1661
Practice Address - Country:US
Practice Address - Phone:412-527-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20628OtherPHARMACY LICENSE MARYLAND