Provider Demographics
NPI:1467440149
Name:MARSHALL'S DRUG STORE INCORPORATED
Entity Type:Organization
Organization Name:MARSHALL'S DRUG STORE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-758-5344
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175-0310
Mailing Address - Country:US
Mailing Address - Phone:804-758-5344
Mailing Address - Fax:804-758-3366
Practice Address - Street 1:50 CROSS ST
Practice Address - Street 2:
Practice Address - City:URBANNA
Practice Address - State:VA
Practice Address - Zip Code:23175-0310
Practice Address - Country:US
Practice Address - Phone:804-758-5344
Practice Address - Fax:804-758-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201000441333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0085-00444Medicaid
4810025OtherNABP
VA0085-00444Medicaid