Provider Demographics
NPI:1669659264
Name:BOSS, MARSHA M (PD)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:M
Last Name:BOSS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2624
Mailing Address - Country:US
Mailing Address - Phone:501-224-0780
Mailing Address - Fax:501-227-0781
Practice Address - Street 1:152 PEBBLE BEACH DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2624
Practice Address - Country:US
Practice Address - Phone:501-224-0780
Practice Address - Fax:501-227-0781
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist