Provider Demographics
NPI:1124128251
Name:MARLAND, VICKY JO (RPH)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:JO
Last Name:MARLAND
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 1:5041 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6255
Mailing Address - Country:US
Mailing Address - Phone:563-332-7272
Mailing Address - Fax:
Practice Address - Street 1:3513 VINE CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5823
Practice Address - Country:US
Practice Address - Phone:563-386-3220
Practice Address - Fax:563-386-4715
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18096183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist