Healthcare Provider Details

I. General information

NPI: 1477560498
Provider Name (Legal Business Name): MARC GLASSMAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 ANDREWS RD
MENTOR ON THE LAKE OH
44060-8532
US

IV. Provider business mailing address

5841 W 130TH ST
PARMA OH
44130-9308
US

V. Phone/Fax

Practice location:
  • Phone: 440-257-5961
  • Fax: 440-257-5993
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number21386530
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID FLORMAN
Title or Position: 3RD PARTY ADMIN
Credential:
Phone: 216-265-7700