Provider Demographics
NPI:1245478684
Name:FELTON, MARLIN LAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:MARLIN
Middle Name:LAYNE
Last Name:FELTON
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 1:830 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8541
Mailing Address - Country:US
Mailing Address - Phone:909-894-9940
Mailing Address - Fax:
Practice Address - Street 1:830 DEERFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333
Practice Address - Country:US
Practice Address - Phone:909-894-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39265183500000X
ID4540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist