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Organization
MARYMOUNT HOSPITAL
Active
Organization
MARYMOUNT HOSPITAL
Active
Other names
MARYMOUNT FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM LONGVILLE MHA, RPH (CHIEF ACCOUNTING OFFICER AND CONTRO)
(216) 636-7416
Entity
Organization
Contact information
Practice address
12000 MCCRACKEN RD, STE 151, GARFIELD HEIGHTS, OH 44125-2964
(216) 578-8822
(216) 587-8844
Mailing address
PO BOX 931783, CLEVELAND, OH 44193-1884
(216) 445-2357
(216) 445-0025
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
021567350
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3674101
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/19/2006
Last updated
10/11/2023
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