Provider Demographics
NPI:1598950453
Name:BULLOCH, MARILYN NOVELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:NOVELL
Last Name:BULLOCH
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 1:1605 KATHY LN
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-1464
Mailing Address - Country:US
Mailing Address - Phone:276-732-2353
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY MEDICAL CTR
Practice Address - Street 2:BOX 870326
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:276-732-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15543183500000X
VA0202207988183500000X
WVRP00007154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist