Provider Demographics
NPI:1962794974
Name:MARSHALL, JOSEPH ETHAN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ETHAN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LENOX PL
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-7520
Mailing Address - Country:US
Mailing Address - Phone:205-317-6642
Mailing Address - Fax:615-773-2308
Practice Address - Street 1:11222 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5504
Practice Address - Country:US
Practice Address - Phone:615-773-2300
Practice Address - Fax:615-773-2308
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist