Provider Demographics
NPI:1699878652
Name:MARION PHARMACY INC
Entity type:Organization
Organization Name:MARION PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-743-2441
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:103 EAST MAIN
Mailing Address - City:MARION
Mailing Address - State:MI
Mailing Address - Zip Code:49665
Mailing Address - Country:US
Mailing Address - Phone:231-743-2441
Mailing Address - Fax:231-743-2973
Practice Address - Street 1:103 EAST MAIN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MI
Practice Address - Zip Code:49665
Practice Address - Country:US
Practice Address - Phone:231-743-2441
Practice Address - Fax:231-743-2973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-05-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-05-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2336281Medicaid
0552800001Medicare ID - Type Unspecified