Provider Demographics
NPI:1447662143
Name:BLANE, MARLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARLIN
Middle Name:
Last Name:BLANE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 DONELSON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-3724
Mailing Address - Country:US
Mailing Address - Phone:931-232-0123
Mailing Address - Fax:931-232-1185
Practice Address - Street 1:1307 DONELSON PKWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3724
Practice Address - Country:US
Practice Address - Phone:931-232-0123
Practice Address - Fax:931-232-1185
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist