Provider Demographics
NPI:1497760334
Name:MARC GLASSMAN INC
Entity Type:Organization
Organization Name:MARC GLASSMAN INC
Other - Org Name:XPECT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:3RD PARTY ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORMAN
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:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:480 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2529
Practice Address - Country:US
Practice Address - Phone:203-877-7828
Practice Address - Fax:203-882-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
CT1411333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004139681Medicaid
0713950OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CT004139681Medicaid