Provider Demographics
NPI:1649851205
Name:MARSLAND, DARRELL
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:MARSLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6215
Mailing Address - Country:US
Mailing Address - Phone:512-847-3048
Mailing Address - Fax:866-597-5413
Practice Address - Street 1:14501 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6215
Practice Address - Country:US
Practice Address - Phone:512-847-3048
Practice Address - Fax:512-842-3783
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132126183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician