Provider Demographics
NPI:1568620417
Name:MARIETTA MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARIETTA MEMORIAL HOSPITAL
Other - Org Name:MARIETTA MEMORIAL SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-374-6090
Mailing Address - Street 1:401 MATTHEW ST
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1635
Mailing Address - Country:US
Mailing Address - Phone:740-374-1446
Mailing Address - Fax:740-568-5484
Practice Address - Street 1:799 FARSON ST STE 214
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1044
Practice Address - Country:US
Practice Address - Phone:740-374-1583
Practice Address - Fax:740-374-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117788OtherPK