Provider Demographics
NPI:1205125994
Name:EDWARDS, MARSHALL LYNN (RPH)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GLYNNVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-7963
Mailing Address - Country:US
Mailing Address - Phone:606-886-1255
Mailing Address - Fax:
Practice Address - Street 1:103 GLYNNVIEW PLZ
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-7963
Practice Address - Country:US
Practice Address - Phone:606-886-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010030183500000X
VA0202005302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist