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Contact Information

MARISSA FOOD MART
700 E. LYONS ST.
MARISSA, IL62257
 Phone: 618-295-2317
 Fax: 618-295-2318
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for MARISSA FOOD MART

NPI # 1003980111
LBN Legal business name MARISSA FOOD MART
Authorized official GAIL LASKOWSKI - (SECRETARY OF CORP.)
Entity Organization
Organization subpart 1 Yes
Enumeration date 11/20/2006
Last updated 04/15/2015 - About 11 years ago
Identifiers
IL License # 054.009766
IL Other 054009766 LICENSE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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