=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487798518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC'S VILLAGE PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 02/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 E MAIN ST
-----------------------------------------------------
City | ELMSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10523-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-592-8211
-----------------------------------------------------
Fax | 914-592-8212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 E MAIN ST
-----------------------------------------------------
City | ELMSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10523-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-592-8211
-----------------------------------------------------
Fax | 914-592-8212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MARC L. LEVITT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 914-592-8211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 0390051
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------