Provider Demographics
NPI:1346905692
Name:KOEN, MARSHALL FRANKLIN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:FRANKLIN
Last Name:KOEN
Suffix:III
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 1:4100 DALE EARNHARDT WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2389
Mailing Address - Country:US
Mailing Address - Phone:972-365-7159
Mailing Address - Fax:
Practice Address - Street 1:4100 DALE EARNHARDT WAY STE 200
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2389
Practice Address - Country:US
Practice Address - Phone:972-365-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist