Provider Demographics
NPI:1194725101
Name:COX, MARCUS W (RPH)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:W
Last Name:COX
Suffix:
Gender:M
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:CHILOQUIN
Mailing Address - State:OR
Mailing Address - Zip Code:97624
Mailing Address - Country:US
Mailing Address - Phone:541-783-3551
Mailing Address - Fax:541-783-3554
Practice Address - Street 1:330 CHILOQUIN BLVD
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624-6773
Practice Address - Country:US
Practice Address - Phone:541-783-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0009602183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR115761Medicaid
ORBK3569944OtherDEA