Provider Demographics
NPI:1417044173
Name:CLARION DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:CLARION DEVELOPMENT CORPORATION
Other - Org Name:MARIENVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-927-8700
Mailing Address - Street 1:120 CHERRY ST.
Mailing Address - Street 2:P.O. BOX 434
Mailing Address - City:MARIENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16239
Mailing Address - Country:US
Mailing Address - Phone:814-927-8700
Mailing Address - Fax:814-927-8142
Practice Address - Street 1:120 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MARIENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16239
Practice Address - Country:US
Practice Address - Phone:814-927-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARION DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415304L333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007277670007Medicaid
PA1007277670007Medicaid