Provider Demographics
NPI:1639761927
Name:WATERS, MARLA LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:LYNN
Last Name:WATERS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:135 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5870
Mailing Address - Country:US
Mailing Address - Phone:770-757-8060
Mailing Address - Fax:
Practice Address - Street 1:199 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1301
Practice Address - Country:US
Practice Address - Phone:706-253-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist