Provider Demographics
NPI:1669509956
Name:ALLAN, MARSHALL STUART (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:STUART
Last Name:ALLAN
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 1:15726 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9429
Mailing Address - Country:US
Mailing Address - Phone:419-335-7022
Mailing Address - Fax:
Practice Address - Street 1:15726 COUNTY RD E
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9429
Practice Address - Country:US
Practice Address - Phone:419-335-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-12198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-1-12198OtherSTATE PHARMACY LICENSE