Provider Demographics
NPI:1568930550
Name:VANPELT, MARSHA RENEE (RPH)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:RENEE
Last Name:VANPELT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7869
Mailing Address - Country:US
Mailing Address - Phone:229-412-0651
Mailing Address - Fax:
Practice Address - Street 1:2815 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1806
Practice Address - Country:US
Practice Address - Phone:229-253-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29738183500000X
GARPH025821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist