Provider Demographics
NPI:1114072592
Name:MARX, GARY NONE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:NONE
Last Name:MARX
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 1:8070 SITIO TOLEDO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9552
Mailing Address - Country:US
Mailing Address - Phone:760-753-4987
Mailing Address - Fax:760-944-9706
Practice Address - Street 1:8070 SITIO TOLEDO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-9552
Practice Address - Country:US
Practice Address - Phone:760-753-4987
Practice Address - Fax:760-944-9706
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORLICENSE # RPH0008242OtherPHARMACIST LICENSE NUMBER
CALICENSE # 26880OtherPHARMACIST LICENSE NUMBER
MILICENSE # 5302020573OtherPHARMACIST LICENSE FOR MI