Provider Demographics
NPI:1164189189
Name:MARLOW, ANDREW GEORGE (CPHT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:GEORGE
Last Name:MARLOW
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W ORVIS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1891
Mailing Address - Country:US
Mailing Address - Phone:315-296-8224
Mailing Address - Fax:
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1934
Practice Address - Country:US
Practice Address - Phone:315-769-3484
Practice Address - Fax:315-769-2630
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10078556183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician