1952631616 NPI number — COMMUNITY DRUG BOARD, INC

Table of content: (NPI 1952631616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952631616 NPI number — COMMUNITY DRUG BOARD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY DRUG BOARD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952631616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 E MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44305-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-315-2666
Provider Business Mailing Address Fax Number:
330-315-5230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44305-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-379-2760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
330-315-2666

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , with the licence number: 34.002564 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X , with the licence number: 34.002564 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 34.002564 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: 34.002564 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 36D0340567 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0674060 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".