Provider Demographics
NPI:1285079475
Name:FAUST, MARSHALL KEITH (DPH)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:KEITH
Last Name:FAUST
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 STONEHENGE CV N
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-3088
Mailing Address - Country:US
Mailing Address - Phone:901-377-2009
Mailing Address - Fax:901-377-2009
Practice Address - Street 1:3613 STONEHENGE CV N
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-3088
Practice Address - Country:US
Practice Address - Phone:901-377-2009
Practice Address - Fax:901-377-2009
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist