Provider Demographics
NPI:1942217963
Name:MARSH DRUGS LLC
Entity Type:Organization
Organization Name:MARSH DRUGS LLC
Other - Org Name:MAINSTREET MARKET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-741-1326
Mailing Address - Street 1:3910 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5440
Mailing Address - Country:US
Mailing Address - Phone:765-741-1326
Mailing Address - Fax:765-741-1329
Practice Address - Street 1:3910 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5440
Practice Address - Country:US
Practice Address - Phone:765-741-1326
Practice Address - Fax:765-741-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60005591A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200836630AMedicaid
2024449OtherPK
1229650033Medicare NSC