Provider Demographics
NPI:1952399651
Name:DAUGHERTY, MARCI LYNN (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:MARCI
Middle Name:LYNN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16168 HOWDEN DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5522
Mailing Address - Country:US
Mailing Address - Phone:317-450-0681
Mailing Address - Fax:
Practice Address - Street 1:16168 HOWDEN DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-5522
Practice Address - Country:US
Practice Address - Phone:317-450-0681
Practice Address - Fax:317-755-0673
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021357A183500000X
OH03120858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20858OtherPHARMACY LICENSE
IN26021357AOtherPHARMACY LICENSE