Provider Demographics
NPI:1083997258
Name:BANKS, MARLA ALDRIDGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:ALDRIDGE
Last Name:BANKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVERSTONE VIS STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6630
Mailing Address - Country:US
Mailing Address - Phone:706-258-4140
Mailing Address - Fax:
Practice Address - Street 1:120 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2303
Practice Address - Country:US
Practice Address - Phone:678-880-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34248183500000X
GA020252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist