Provider Demographics
NPI:1225536345
Name:CHILDS, MARVIN S II (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:S
Last Name:CHILDS
Suffix:II
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1036
Mailing Address - Country:US
Mailing Address - Phone:423-254-6672
Mailing Address - Fax:423-254-6674
Practice Address - Street 1:4331 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1036
Practice Address - Country:US
Practice Address - Phone:423-254-6672
Practice Address - Fax:423-254-6674
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist