Provider Demographics
NPI:1659681260
Name:MARSHALL PHARMACY
Entity Type:Organization
Organization Name:MARSHALL PHARMACY
Other - Org Name:MARSHALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-873-3244
Mailing Address - Street 1:701 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:WI
Mailing Address - Zip Code:53559-8982
Mailing Address - Country:US
Mailing Address - Phone:608-655-8600
Mailing Address - Fax:
Practice Address - Street 1:701 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:WI
Practice Address - Zip Code:53559-8982
Practice Address - Country:US
Practice Address - Phone:608-655-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI9039-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5132383OtherNCPDP PROVIDER IDENTIFICATION NUMBER