Provider Demographics
NPI:1821003765
Name:MARC GLASSMAN INC
Entity Type:Organization
Organization Name:MARC GLASSMAN INC
Other - Org Name:MARCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLORAN
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 1:7511 W RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5536
Practice Address - Country:US
Practice Address - Phone:440-843-5495
Practice Address - Fax:440-843-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20805800333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0998890Medicaid
3660366OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3660366OtherOTHER ID NUMBER-COMMERCIAL NUMBER