Provider Demographics
NPI:1629389846
Name:BARSCH, MARY LEGG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEGG
Last Name:BARSCH
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 1:802 ATKINSON DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3902
Mailing Address - Country:US
Mailing Address - Phone:706-537-1277
Mailing Address - Fax:
Practice Address - Street 1:1247 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3958
Practice Address - Country:US
Practice Address - Phone:706-428-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21011183500000X
AK1254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist