Provider Demographics
NPI:1831352855
Name:PATRICK, MARCUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:PATRICK
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 1:1540 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9300
Mailing Address - Country:US
Mailing Address - Phone:304-638-2507
Mailing Address - Fax:
Practice Address - Street 1:102 BRADY DR
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-2220
Practice Address - Country:US
Practice Address - Phone:304-638-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist