Provider Demographics
NPI:1548455488
Name:MARSHALL, SCOTT WALTER (PHARMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WALTER
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 E PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3525
Mailing Address - Country:US
Mailing Address - Phone:801-587-0600
Mailing Address - Fax:
Practice Address - Street 1:585 KOMAS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1231
Practice Address - Country:US
Practice Address - Phone:801-587-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333852-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist