Provider Demographics
NPI:1528274883
Name:IRVIN, MARLA LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:LEE
Last Name:IRVIN
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 1:9469 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6725
Mailing Address - Country:US
Mailing Address - Phone:513-791-6649
Mailing Address - Fax:
Practice Address - Street 1:10828 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-2812
Practice Address - Country:US
Practice Address - Phone:513-792-7080
Practice Address - Fax:513-792-3838
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist