Provider Demographics
NPI:1477969376
Name:TOLLISON, MARY-MURK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY-MURK
Middle Name:
Last Name:TOLLISON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2531
Mailing Address - Country:US
Mailing Address - Phone:864-297-4621
Mailing Address - Fax:864-234-1422
Practice Address - Street 1:315 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2531
Practice Address - Country:US
Practice Address - Phone:864-297-4621
Practice Address - Fax:864-234-1422
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist