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General NPI Number Information
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NPI Number | 1851649529
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Entity Type | Individual
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Provider Name | MARK CHISMAR
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Gender | Male
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 55 S 23RD ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-2180
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Country | US
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Telephone | 740-432-3810
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Fax | 740-432-6803
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Provider Business Mailing Address
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Address Line | 55 S 23RD ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-2180
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Country | US
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Telephone | 740-432-3810
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Fax | 740-432-6803
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03213227
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License Number State | OH
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