Provider Demographics
NPI:1124230834
Name:MAGILL, MARC D (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:D
Last Name:MAGILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1304
Mailing Address - Country:US
Mailing Address - Phone:515-246-1390
Mailing Address - Fax:515-280-5106
Practice Address - Street 1:3221 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1304
Practice Address - Country:US
Practice Address - Phone:515-246-1390
Practice Address - Fax:515-280-5106
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014480Medicaid