1063707289 NPI number — DR. KELLY LOUISE MARCIN PHARMD

Table of content: DR. KELLY LOUISE MARCIN PHARMD (NPI 1063707289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063707289 NPI number — DR. KELLY LOUISE MARCIN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCIN
Provider First Name:
KELLY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063707289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 CONSTANT FRIENDSHIP BLVD
Provider Second Line Business Mailing Address:
T-1871
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21009-2566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-670-9001
Provider Business Mailing Address Fax Number:
410-670-9001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 CONSTANT FRIENDSHIP BLVD
Provider Second Line Business Practice Location Address:
T-1871
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21009-2566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-670-9001
Provider Business Practice Location Address Fax Number:
410-670-9001
Provider Enumeration Date:
06/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  14303 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com