Provider Demographics
NPI:1154491181
Name:WILLIS, MARSHA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:B
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22802 QUIET LAKE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5736
Mailing Address - Country:US
Mailing Address - Phone:281-395-8242
Mailing Address - Fax:281-344-4600
Practice Address - Street 1:2100 PRESTON ST
Practice Address - Street 2:RICHMOND STATE SCHOOL PHARMACY
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-1419
Practice Address - Country:US
Practice Address - Phone:281-344-4601
Practice Address - Fax:281-344-4600
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21294183500000X
AL7481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist