Provider Demographics
NPI:1881892750
Name:BLOODWORTH, MARSHA LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:LYNN
Last Name:BLOODWORTH
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 1:9635 CAFE TER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4989
Mailing Address - Country:US
Mailing Address - Phone:210-451-9234
Mailing Address - Fax:
Practice Address - Street 1:2200 BERQUIST DRIVE
Practice Address - Street 2:WILFORD HALL MED CENTER PHARMACY SQUADRON
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33547183500000X
WY2110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist