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General NPI Number Information
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NPI Number | 1366526006
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Entity Type | Organization
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Legal Business Name | MARK V COBERLY
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 4195 MASSILLION RD STE B
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City | UNION TOWN
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State | OH
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Zip | 44685
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Country | US
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Telephone | 330-896-0212
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Fax | 330-896-0682
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Provider Business Mailing Address
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Address Line | 4195 MASSILLION RD STE B
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City | UNION TOWN
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State | OH
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Zip | 44685
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Country | US
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Telephone | 330-896-0212
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Fax | 330-896-0682
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Authorized Official
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Title or Position | OWNER
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Name | MARK COBERLY
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Credential |
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Telephone | 330-896-0212
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03 2 12837
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 02588950
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License Number State | OH
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