Provider Demographics
NPI:1477997047
Name:MARKS, EDWIN TIMOTHY (RPH)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:TIMOTHY
Last Name:MARKS
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 1:6232 76TH DR SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-6034
Mailing Address - Country:US
Mailing Address - Phone:425-335-0330
Mailing Address - Fax:425-335-0330
Practice Address - Street 1:1301 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1711
Practice Address - Country:US
Practice Address - Phone:360-568-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist