Provider Demographics
NPI:1659976355
Name:MCLARNON, MARK BANKS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BANKS
Last Name:MCLARNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S TRADE DAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2405
Mailing Address - Country:US
Mailing Address - Phone:903-567-6516
Mailing Address - Fax:903-567-5139
Practice Address - Street 1:1215 S TRADE DAYS BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2405
Practice Address - Country:US
Practice Address - Phone:903-567-6516
Practice Address - Fax:903-567-5139
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist