Provider Demographics
NPI:1710263280
Name:TUETKEN, MARSHALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:TUETKEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5114
Mailing Address - Country:US
Mailing Address - Phone:319-480-4246
Mailing Address - Fax:
Practice Address - Street 1:2609 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-5114
Practice Address - Country:US
Practice Address - Phone:937-322-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16000-40183500000X
OH03132538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist