Provider Demographics
NPI:1073828471
Name:SILVER, MARVIN LESLIE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:LESLIE
Last Name:SILVER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 CLUB VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5659
Mailing Address - Country:US
Mailing Address - Phone:661-273-4379
Mailing Address - Fax:
Practice Address - Street 1:44226 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4134
Practice Address - Country:US
Practice Address - Phone:661-948-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist