Provider Demographics
NPI:1740582774
Name:MARKS PHARMACY LLC
Entity Type:Organization
Organization Name:MARKS PHARMACY LLC
Other - Org Name:MARK'S HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-631-5547
Mailing Address - Street 1:836 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2743
Mailing Address - Country:US
Mailing Address - Phone:828-631-5547
Mailing Address - Fax:828-631-5546
Practice Address - Street 1:836 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2743
Practice Address - Country:US
Practice Address - Phone:828-631-5547
Practice Address - Fax:828-631-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC106653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127721OtherPK
NC1740582774Medicaid