Provider Demographics
NPI:1770183220
Name:MARVIN, TONY (RPH)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:MARVIN
Suffix:
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 1:9810 HIGHWAY N
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1739
Mailing Address - Country:US
Mailing Address - Phone:660-707-3539
Mailing Address - Fax:
Practice Address - Street 1:1000 GRAVES ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3071
Practice Address - Country:US
Practice Address - Phone:660-646-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002014007OtherMISSOURI BOARD OF PHARMACY