Provider Demographics
NPI:1235211038
Name:MARC DRUG COMPANY
Entity Type:Organization
Organization Name:MARC DRUG COMPANY
Other - Org Name:BETTMANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-274-2101
Mailing Address - Street 1:2350 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2103
Mailing Address - Country:US
Mailing Address - Phone:937-274-2101
Mailing Address - Fax:937-276-8455
Practice Address - Street 1:2350 CATALPA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2103
Practice Address - Country:US
Practice Address - Phone:937-274-2101
Practice Address - Fax:937-276-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0200870003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3604344OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH0686753Medicaid
0304040001Medicare NSC