Healthcare Provider Details

I. General information

NPI: 1437147717
Provider Name (Legal Business Name): MARION PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 SOUTH MAIN ST.
MARION NY
14505
US

IV. Provider business mailing address

PO BOX 47
MARION NY
14505-0047
US

V. Phone/Fax

Practice location:
  • Phone: 315-926-5636
  • Fax:
Mailing address:
  • Phone: 315-926-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number022531
License Number StateNY

VIII. Authorized Official

Name: MR. PAUL E. JOHNSON
Title or Position: PRESIDENT
Credential: RPH
Phone: 315-926-5636