Provider Demographics
NPI:1093733206
Name:MARLOWE, JERRY S (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:S
Last Name:MARLOWE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1893
Mailing Address - Country:US
Mailing Address - Phone:330-343-3199
Mailing Address - Fax:330-602-0918
Practice Address - Street 1:207 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1893
Practice Address - Country:US
Practice Address - Phone:330-343-3199
Practice Address - Fax:330-602-0918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-07545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist