Provider Demographics
NPI:1174848766
Name:MARLOW, JEFFREY L (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:MARLOW
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 1:15909 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2101
Mailing Address - Country:US
Mailing Address - Phone:636-391-4064
Mailing Address - Fax:636-527-7385
Practice Address - Street 1:15909 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2101
Practice Address - Country:US
Practice Address - Phone:636-391-4064
Practice Address - Fax:636-527-7385
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.033824183500000X
MO042019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist