Provider Demographics
NPI:1639464274
Name:SIRK, MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:SIRK
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 1:1701 GALLERIA BLVD
Mailing Address - Street 2:T-0695
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1602
Mailing Address - Country:US
Mailing Address - Phone:615-771-9588
Mailing Address - Fax:615-771-9588
Practice Address - Street 1:1701 GALLERIA BLVD
Practice Address - Street 2:T-0695
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1602
Practice Address - Country:US
Practice Address - Phone:615-771-9588
Practice Address - Fax:615-771-9588
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist