Provider Demographics
NPI:1316036965
Name:SNYDER-MARK ROSELLE DRUGS INC
Entity Type:Organization
Organization Name:SNYDER-MARK ROSELLE DRUGS INC
Other - Org Name:MARK DRUGS ROSELLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-529-3400
Mailing Address - Street 1:384 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2007
Mailing Address - Country:US
Mailing Address - Phone:630-529-3400
Mailing Address - Fax:630-529-3429
Practice Address - Street 1:384 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2007
Practice Address - Country:US
Practice Address - Phone:630-529-3400
Practice Address - Fax:630-529-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
IL054.0099543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363716954001Medicaid
2020526OtherPK
2020526OtherPK