Provider Demographics
NPI:1306126024
Name:MARS, ALWYN KENRICK (RPH)
Entity type:Individual
Prefix:
First Name:ALWYN
Middle Name:KENRICK
Last Name:MARS
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 1:3950 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-5144
Mailing Address - Country:US
Mailing Address - Phone:407-681-6366
Mailing Address - Fax:407-681-6359
Practice Address - Street 1:3950 N DEAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-5144
Practice Address - Country:US
Practice Address - Phone:407-681-6366
Practice Address - Fax:407-681-6359
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist