Provider Demographics
NPI:1376624734
Name:MARSHALL, HEATH A (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20017 OAK RIVER DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5610
Mailing Address - Country:US
Mailing Address - Phone:804-590-3033
Mailing Address - Fax:804-265-5624
Practice Address - Street 1:5607 CLAIBORNE RD
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:VA
Practice Address - Zip Code:23885-9303
Practice Address - Country:US
Practice Address - Phone:804-265-5214
Practice Address - Fax:804-265-5624
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist