Provider Demographics
NPI:1659972628
Name:DAVIS, MARSHALL W (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4400
Mailing Address - Country:US
Mailing Address - Phone:270-443-1442
Mailing Address - Fax:270-444-0610
Practice Address - Street 1:250 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4400
Practice Address - Country:US
Practice Address - Phone:270-443-1442
Practice Address - Fax:270-444-0610
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist