Provider Demographics
NPI:1003789108
Name:OUTLAND, MARSHALL HUGH
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:HUGH
Last Name:OUTLAND
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 1:1111 BLACKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4549
Mailing Address - Country:US
Mailing Address - Phone:321-842-1622
Mailing Address - Fax:
Practice Address - Street 1:1111 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4549
Practice Address - Country:US
Practice Address - Phone:321-842-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS69145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist