Provider Demographics
NPI:1205094786
Name:MARSHALL, KEVIN BASIL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BASIL
Last Name:MARSHALL
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 1:1475 N EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1776
Mailing Address - Country:US
Mailing Address - Phone:770-228-4426
Mailing Address - Fax:
Practice Address - Street 1:1475 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1776
Practice Address - Country:US
Practice Address - Phone:770-228-4426
Practice Address - Fax:770-227-3278
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist