Provider Demographics
NPI:1063572006
Name:MOBLEY, MARJORIE (RPH)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MOBLEY
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 1:1322 CHICKASAW DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3721
Mailing Address - Country:US
Mailing Address - Phone:972-644-8746
Mailing Address - Fax:
Practice Address - Street 1:712 N WASHINGTON AVE
Practice Address - Street 2:#414
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1619
Practice Address - Country:US
Practice Address - Phone:214-828-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33511OtherPHARMACIST LICENSE