Provider Demographics
NPI:1891138772
Name:MARSH, JAMIE LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:MARSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12775 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9569
Mailing Address - Country:US
Mailing Address - Phone:716-937-6316
Mailing Address - Fax:
Practice Address - Street 1:12775 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9569
Practice Address - Country:US
Practice Address - Phone:716-937-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057860183500000X
PARP447539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist