Provider Demographics
NPI:1578285169
Name:MARSHALL, KEN K (PHARM D)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:K
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1123
Mailing Address - Country:US
Mailing Address - Phone:434-466-5273
Mailing Address - Fax:
Practice Address - Street 1:1980 RIO HILL CTR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1144
Practice Address - Country:US
Practice Address - Phone:434-978-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist