1841205788 NPI number — MARC GLASSMAN INC

Table of content: (NPI 1841205788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841205788 NPI number — MARC GLASSMAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARC GLASSMAN INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARCS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841205788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5841 W 130TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-9308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7353 MENTOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-7523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-951-1721
Provider Business Practice Location Address Fax Number:
440-951-2004
Provider Enumeration Date:
07/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALLORAN
Authorized Official First Name:
MARY BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY ADMIN
Authorized Official Telephone Number:
216-265-7700

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  20545250 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3649437 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0953991 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".