Provider Demographics
NPI:1699364760
Name:MARSHALL, SANDRA BAILEY
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:BAILEY
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 HIGHWAY 242
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-4383
Mailing Address - Country:US
Mailing Address - Phone:936-525-1200
Mailing Address - Fax:
Practice Address - Street 1:10200 HIGHWAY 242
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-4383
Practice Address - Country:US
Practice Address - Phone:936-525-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician