Provider Demographics
NPI:1013245430
Name:MARSHALL, NENA (RPH)
Entity Type:Individual
Prefix:
First Name:NENA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 FANNIN ST
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2934
Mailing Address - Country:US
Mailing Address - Phone:713-797-1613
Mailing Address - Fax:713-791-9482
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:SUITE 1350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:713-797-1613
Practice Address - Fax:713-791-9482
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX466358Medicaid