Provider Demographics
NPI:1679693642
Name:MARSHALL, PATRICK MEEHAN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MEEHAN
Last Name:MARSHALL
Suffix:JR
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 1:994 WINDMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-6664
Mailing Address - Country:US
Mailing Address - Phone:907-447-1646
Mailing Address - Fax:
Practice Address - Street 1:501 GARY HILL RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4503
Practice Address - Country:US
Practice Address - Phone:803-637-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist