=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205841145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC GLASSMAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4825 DRESSLER RD NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-493-3530
-----------------------------------------------------
Fax | 330-493-0633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5841 W 130TH ST
-----------------------------------------------------
City | PARMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-9308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY ADMIN
-----------------------------------------------------
Name | MARY BETH HALLORAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-265-7700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 20521650
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------