Provider Demographics
NPI:1003153651
Name:FORD, MARSHAUN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARSHAUN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39883 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7802
Mailing Address - Country:US
Mailing Address - Phone:863-421-9245
Mailing Address - Fax:
Practice Address - Street 1:39883 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7802
Practice Address - Country:US
Practice Address - Phone:863-421-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist