Provider Demographics
NPI:1124590575
Name:MARC GLASSMAN INC
Entity Type:Organization
Organization Name:MARC GLASSMAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-265-7700
Mailing Address - Street 1:5841 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9308
Mailing Address - Country:US
Mailing Address - Phone:216-265-7700
Mailing Address - Fax:216-265-7744
Practice Address - Street 1:1799 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1903
Practice Address - Country:US
Practice Address - Phone:216-265-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy