Provider Demographics
NPI:1992246359
Name:POOLOS, MARJORIE ANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANNE
Last Name:POOLOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W DOVE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9106
Mailing Address - Country:US
Mailing Address - Phone:910-964-1491
Mailing Address - Fax:
Practice Address - Street 1:4601 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2138
Practice Address - Country:US
Practice Address - Phone:910-488-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11014OtherNC PHARMACIST LICENSE NUMBER