Provider Demographics
NPI:1780966572
Name:MARSHALL, CASSANDRA YVETTE (RPH)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:YVETTE
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 1:1202 N MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4634
Mailing Address - Country:US
Mailing Address - Phone:850-877-1407
Mailing Address - Fax:
Practice Address - Street 1:1202 N MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4634
Practice Address - Country:US
Practice Address - Phone:850-877-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0025487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist