Healthcare Provider Details

I. General information

NPI: 1669487500
Provider Name (Legal Business Name): MARC GLASSMAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29700 LAKE SHORE BLVD
WILLOWICK OH
44095-4609
US

IV. Provider business mailing address

5841 W 130TH ST
PARMA OH
44130-9308
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-2801
  • Fax: 440-944-8713
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number20591350
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH HALLORAN
Title or Position: PHARMACY ADMIN
Credential:
Phone: 216-265-7700