Provider Demographics
NPI:1992018410
Name:MARK, ARKESHA RENEE
Entity Type:Individual
Prefix:
First Name:ARKESHA
Middle Name:RENEE
Last Name:MARK
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 1:2126 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-3716
Mailing Address - Country:US
Mailing Address - Phone:409-727-1426
Mailing Address - Fax:409-727-0776
Practice Address - Street 1:2126 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-3716
Practice Address - Country:US
Practice Address - Phone:409-727-1426
Practice Address - Fax:409-727-0776
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist