Provider Demographics
NPI:1356614044
Name:MARSH, GARY W (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:MARSH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6124
Mailing Address - Country:US
Mailing Address - Phone:850-522-5321
Mailing Address - Fax:
Practice Address - Street 1:301 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-6124
Practice Address - Country:US
Practice Address - Phone:850-522-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS11785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist