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		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3675189	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1699854570
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	:	CLEVELAND
State	:	OH
Zip	:	44130-9308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 COVENTRY RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1610
Country	:	US
Telephone Number	:	216-320-1005
Fax Number	:	216-320-1015

Authorized Official
Title or Position	:	3RD PARTY ADMIN
Name	:	DAVID FLORMAN
Credential	:
Telephone Number	:	216-265-7700

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/22/2020

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