=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013585470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARATHON HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2021
-----------------------------------------------------
Last Update Date | 08/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6300 N RIVER RD STE 100A
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-421-1016
-----------------------------------------------------
Fax | 847-787-7144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6300 N RIVER RD STE 100A
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-421-1016
-----------------------------------------------------
Fax | 847-787-7144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | ERIN SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-304-1933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------