Provider Demographics
NPI:1295012771
Name:MARROW, ROBERTA JEANNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERTA
Middle Name:JEANNE
Last Name:MARROW
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 1:5700 OVERTON RIDGE BLVD
Mailing Address - Street 2:T-1770
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3220
Mailing Address - Country:US
Mailing Address - Phone:817-423-1661
Mailing Address - Fax:
Practice Address - Street 1:5700 OVERTON RIDGE BLVD
Practice Address - Street 2:T-1770
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3220
Practice Address - Country:US
Practice Address - Phone:817-423-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist