MEDICARE: MARCLO ENTERPRISES, 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	183500000X	Pharmacist	0139-IR	LA

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

General Provider Information

NPI Number	:	1679527477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCLO ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	PO BOX 940
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-0940
Country	:	US
Telephone Number	:	318-992-5088
Fax Number	:	318-992-6446

Provider Business Practice Location Address
First Line	:	1825 EAST OAK ST
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-0940
Country	:	US
Telephone Number	:	318-992-5088
Fax Number	:	318-992-6446

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARTIN E CLOESSNER JR.
Credential	:	PD
Telephone Number	:	318-992-5088

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/09/2008

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Directions to “MARCLO ENTERPRISES, INC ” Practice Location

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