Mark V Coberly

Primary specialty

PharmacyTaxonomy code 333600000X

License

02588950 Issued in OH

Legal business name

MARK V COBERLY

Practice address

4195 Massillion Rd
Ste B
Union Town, OH 44685

Phone

(330) 896-0212

Fax

(330) 896-0682

NPI assigned

Oct 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Coberly

Title

Owner

Phone

(330) 896-0212

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Village Green Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216080000000",
    "number": "1366526006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4195 MASSILLION RD",
            "address_2": "STE B",
            "city": "UNION TOWN",
            "state": "OH",
            "postal_code": "44685",
            "telephone_number": "330-896-0212",
            "fax_number": "330-896-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4195 MASSILLION RD",
            "address_2": "STE B",
            "city": "UNION TOWN",
            "state": "OH",
            "postal_code": "44685",
            "telephone_number": "330-896-0212",
            "fax_number": "330-896-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK V COBERLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-07-15",
        "status": "A",
        "authorized_official_last_name": "COBERLY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-896-0212"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03 2 12837",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OH",
            "license": "02588950",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0573955",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3642750",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Green Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.