1336588391 NPI number — DR. BRETT JOSEPH ALBERT MARRYSHOW PHARMD

Table of content: DR. BRETT JOSEPH ALBERT MARRYSHOW PHARMD (NPI 1336588391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336588391 NPI number — DR. BRETT JOSEPH ALBERT MARRYSHOW PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRYSHOW
Provider First Name:
BRETT
Provider Middle Name:
JOSEPH ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

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:
1336588391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2851 N GREEN VALLEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89014-0402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-435-9849
Provider Business Mailing Address Fax Number:
702-435-8520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2851 N GREEN VALLEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-0402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-435-9849
Provider Business Practice Location Address Fax Number:
702-435-8520
Provider Enumeration Date:
06/22/2013

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:  18016 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 015027 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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