Healthcare Provider Details

I. General information

NPI: 1184639023
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: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 TIFFANY BLVD
YOUNGSTOWN OH
44514-1965
US

IV. Provider business mailing address

5841 W 130TH ST
PARMA OH
44130-9308
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-6371
  • Fax: 330-965-4297
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number21351850
License Number StateOH
# 2
Primary TaxonomyN
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