Provider Demographics
NPI:1134478225
Name:CASON, MARVIN GENE (RPH)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:GENE
Last Name:CASON
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 1:230 APPLE SQUARE PLAZA
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824
Mailing Address - Country:US
Mailing Address - Phone:803-637-3135
Mailing Address - Fax:803-637-3513
Practice Address - Street 1:230 APPLE SQUARE PLAZA
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824
Practice Address - Country:US
Practice Address - Phone:803-637-3135
Practice Address - Fax:803-637-3513
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist