Provider Demographics
NPI:1750674156
Name:MARSHALL, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
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 1:1430 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1593
Mailing Address - Country:US
Mailing Address - Phone:605-642-0650
Mailing Address - Fax:605-642-0263
Practice Address - Street 1:1430 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1593
Practice Address - Country:US
Practice Address - Phone:605-642-0650
Practice Address - Fax:605-642-0263
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist