1487719803 NPI number — MARION PRESCRIPTION INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487719803 NPI number — MARION PRESCRIPTION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION PRESCRIPTION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARION PRESCRIPTION INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487719803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
544 E CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43302-4234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-382-5746
Provider Business Mailing Address Fax Number:
740-382-5745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
544 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43302-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-382-5746
Provider Business Practice Location Address Fax Number:
740-382-5745
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILEY
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARM AND OWNER
Authorized Official Telephone Number:
740-225-9229

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 021292200 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0491909 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3639575 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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