Provider Demographics
NPI:1851621387
Name:PATTERSON, MARCUS D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:D
Last Name:PATTERSON
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 1:1526 RIDGE AVE # CU
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2367
Mailing Address - Country:US
Mailing Address - Phone:267-764-1328
Mailing Address - Fax:267-764-1330
Practice Address - Street 1:1526 RIDGE AVE # CU
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2367
Practice Address - Country:US
Practice Address - Phone:267-764-1328
Practice Address - Fax:267-764-1330
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43856183500000X
PARP453083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist