Active NPI
Mary Ellen Ellen Marshall
- Pharmacist
- Anthem, AZ
National Provider Identifier
1639583040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 31813
- Practice address
- 39510 N Gavilan Peak Pkwy
Anthem, AZ 85086-2777 - Phone
- (623) 551-1031
- Fax
- (623) 551-4924
- NPI assigned
- Jun 13, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13508 | AZ | |
| Pharmacist | 183500000X | 31813 | TX | Primary |
Addresses
Primary practice location
39510 N Gavilan Peak Pkwy
Anthem, AZ 85086-2777
Mailing address
39510 N Gavilan Peak Pkwy
Anthem, AZ 85086-2777
Phone (623) 551-1031
Other names 1
- Mary Ellen Marshall
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13508 | AZ | MD | Pharmacist |
| 31813 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| German Dobson CVS LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402617600000",
"number": "1639583040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39510 N GAVILAN PEAK PKWY",
"city": "ANTHEM",
"state": "AZ",
"postal_code": "850862777",
"telephone_number": "623-551-1031",
"fax_number": "623-551-4924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39510 N GAVILAN PEAK PKWY",
"city": "ANTHEM",
"state": "AZ",
"postal_code": "850862777",
"telephone_number": "623-551-1031",
"fax_number": "623-551-4924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "MARY ELLEN",
"middle_name": "ELLEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-13",
"last_updated": "2014-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "13508",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "31813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "MARSHALL",
"middle_name": "ELLEN",
"credential": "RPH",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Anthem, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.