Healthcare Provider Details

I. General information

NPI: 1720023955
Provider Name (Legal Business Name): MARYSIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 NORTHGATE PLZ UNIT 2
HARMONY PA
16037-9257
US

IV. Provider business mailing address

8571 FOXWOOD CT SUITE A
POLAND OH
44514-4313
US

V. Phone/Fax

Practice location:
  • Phone: 724-452-5334
  • Fax: 724-452-5592
Mailing address:
  • Phone: 330-318-3926
  • Fax: 330-318-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481568
License Number StatePA

VIII. Authorized Official

Name: RONALD MCDERMOTT
Title or Position: SVP OPERATIONS
Credential:
Phone: 330-318-3926