Healthcare Provider Details

I. General information

NPI: 1295013779
Provider Name (Legal Business Name): MARC EARL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE JJN1-02
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

21261 ALMAR DR
SHAKER HEIGHTS OH
44122-3820
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-9540
  • Fax:
Mailing address:
  • Phone: 216-445-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03226278
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: