MEDICARE: MARC GLASSMAN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	20968650	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3646607	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1588679427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARC GLASSMAN INC

Provider Business Mailing Address
First Line	:	5841 W 130TH ST
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44130-9308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22840 LAKE SHORE BLVD
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1321
Country	:	US
Telephone Number	:	216-731-7474
Fax Number	:	216-731-1764

Authorized Official
Title or Position	:	PHARMACY ADMIN
Name	:	MARY BETH HALLORAN
Credential	:
Telephone Number	:	216-265-7700

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	01/27/2017

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Directions to “MARC GLASSMAN INC ” Practice Location

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