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
—
—
3336C0002X
Clinic Pharmacy
—
—
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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