Provider Demographics
NPI:1487719803
Name:MARION PRESCRIPTION INC
Entity type:Organization
Organization Name:MARION PRESCRIPTION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-225-9229
Mailing Address - Street 1:544 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4234
Mailing Address - Country:US
Mailing Address - Phone:740-382-5746
Mailing Address - Fax:740-382-5745
Practice Address - Street 1:544 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4234
Practice Address - Country:US
Practice Address - Phone:740-382-5746
Practice Address - Fax:740-382-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0212922003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0491909Medicaid
3639575OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5134450001Medicare NSC