Provider Demographics
NPI:1093032468
Name:THE METROHEALTH SYSTEM
Entity Type:Organization
Organization Name:THE METROHEALTH SYSTEM
Other - Org Name:METROHEALTH SYSTEM MAILORDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHIONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-778-7176
Mailing Address - Street 1:PO BOX 73122
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7770
Practice Address - Fax:216-778-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0200355503336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1564543Medicaid
3678919OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0364550003Medicare NSC