Provider Demographics
NPI:1497860431
Name:MARKLIN ENTERPRISES LLC
Entity Type:Organization
Organization Name:MARKLIN ENTERPRISES LLC
Other - Org Name:HERITAGE SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHRNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-854-4949
Mailing Address - Street 1:P.O. BOX 272
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-0272
Mailing Address - Country:US
Mailing Address - Phone:330-854-4949
Mailing Address - Fax:330-854-1919
Practice Address - Street 1:977 E CHERRY
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-0272
Practice Address - Country:US
Practice Address - Phone:330-854-4949
Practice Address - Fax:330-854-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRTP0218851503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352363Medicaid
2075474OtherPK