Provider Demographics
NPI:1700889524
Name:BARRON CHAGRIN DRUG, INC.
Entity Type:Organization
Organization Name:BARRON CHAGRIN DRUG, INC.
Other - Org Name:BARRON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:216-360-0500
Mailing Address - Street 1:23632 MERCANTILE RD
Mailing Address - Street 2:STE F
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5916
Mailing Address - Country:US
Mailing Address - Phone:216-360-0500
Mailing Address - Fax:216-360-0506
Practice Address - Street 1:23632 MERCANTILE RD
Practice Address - Street 2:STE F
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5916
Practice Address - Country:US
Practice Address - Phone:216-360-0500
Practice Address - Fax:216-360-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007085Medicaid
OH0007085Medicaid