Provider Demographics
NPI:1194849760
Name:MAREK, JOSEPH SR (RPH CGP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MAREK
Suffix:SR
Gender:M
Credentials:RPH CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SHELTON CIR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4259
Mailing Address - Country:US
Mailing Address - Phone:440-263-1752
Mailing Address - Fax:
Practice Address - Street 1:1103 SHELTON CIR
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4259
Practice Address - Country:US
Practice Address - Phone:440-263-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-184551835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric