Provider Demographics
NPI:1689987398
Name:DERKOWSKI, MARILYN KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:KAY
Last Name:DERKOWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:KAY
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10718 POTRANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3312
Mailing Address - Country:US
Mailing Address - Phone:210-681-2301
Mailing Address - Fax:210-681-5736
Practice Address - Street 1:10718 POTRANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3312
Practice Address - Country:US
Practice Address - Phone:210-681-2301
Practice Address - Fax:210-681-5736
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist