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General NPI Number Information
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NPI Number | 1295990885
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Entity Type | Organization
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Legal Business Name | MARCS VARIETY STORE INC
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 13693 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-3437
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Country | US
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Telephone | 216-476-6770
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Fax | 216-476-6770
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Provider Business Mailing Address
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Address Line | 5841 W 130TH ST
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City | PARMA
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State | OH
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Zip | 44130-9308
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Country | US
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Telephone | 216-265-7700
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Fax | 216-265-7744
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Authorized Official
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Title or Position | 3RD PARTY ADMINISTRATOR
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Name | MR. DAVID FLORMAN
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Credential |
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Telephone | 216-265-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 020990300
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 020990300
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License Number State | OH
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