Provider Demographics
NPI:1851649529
Name:CHISMAR, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHISMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2180
Mailing Address - Country:US
Mailing Address - Phone:740-432-3810
Mailing Address - Fax:740-432-6803
Practice Address - Street 1:55 S 23RD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2180
Practice Address - Country:US
Practice Address - Phone:740-432-3810
Practice Address - Fax:740-432-6803
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist