Provider Demographics
NPI:1396025003
Name:WARNER, MARK C (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:WARNER
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 1:943 MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4416
Mailing Address - Country:US
Mailing Address - Phone:276-632-6457
Mailing Address - Fax:276-632-6488
Practice Address - Street 1:943 MULBERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4416
Practice Address - Country:US
Practice Address - Phone:276-632-6457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205002183500000X
MAPH21689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist