Provider Demographics
NPI:1962554410
Name:MARKS, BARRY ALEXANDER (RPH)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:ALEXANDER
Last Name:MARKS
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 57
Mailing Address - Street 2:419 MAIN ST
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15851
Mailing Address - Country:US
Mailing Address - Phone:814-653-8295
Mailing Address - Fax:
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15851
Practice Address - Country:US
Practice Address - Phone:814-653-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029561L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005835570001Medicaid
PA1037610001Medicare ID - Type Unspecified