Healthcare Provider Details

I. General information

NPI: 1699878652
Provider Name (Legal Business Name): MARION PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 05/06/2008

III. Provider practice location address

103 EAST MAIN
MARION MI
49665
US

IV. Provider business mailing address

PO BOX J 103 EAST MAIN
MARION MI
49665
US

V. Phone/Fax

Practice location:
  • Phone: 231-743-2441
  • Fax: 231-743-2973
Mailing address:
  • Phone: 231-743-2441
  • Fax: 231-743-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS L ANDERSON
Title or Position: OWNER
Credential: RPH
Phone: 231-743-2441