Provider Demographics
NPI:1295990885
Name:MARCS VARIETY STORE INC
Entity type:Organization
Organization Name:MARCS VARIETY STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:3RD PARTY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORMAN
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:216-265-7700
Mailing Address - Fax:216-265-7744
Practice Address - Street 1:13693 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3437
Practice Address - Country:US
Practice Address - Phone:216-476-6770
Practice Address - Fax:216-476-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0209903003336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1163820001Medicare NSC