Provider Demographics
NPI:1285750612
Name:MCGLYNN, MARY MARSHALL
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARSHALL
Last Name:MCGLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 CUTSHAW AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3838
Mailing Address - Country:US
Mailing Address - Phone:804-355-4110
Mailing Address - Fax:804-752-2154
Practice Address - Street 1:253 N WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1623
Practice Address - Country:US
Practice Address - Phone:804-798-4576
Practice Address - Fax:804-752-2154
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist