1316935976 NPI number — DECARIA BROTHERS INC

Table of content: (NPI 1316935976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316935976 NPI number — DECARIA BROTHERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECARIA BROTHERS 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:
MEDICAL EXPRESS PHARMACY SERVICES
Provider Other Organization Name Type Code:
3
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:
1316935976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 E 5TH ST # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920-3031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-385-6339
Provider Business Mailing Address Fax Number:
330-385-1400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 E 5TH ST # 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E LIVERPOOL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43920-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-385-6339
Provider Business Practice Location Address Fax Number:
330-385-1400
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MADER
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR OF CLINICAL SVCS
Authorized Official Telephone Number:
330-385-6339

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 021473300 , 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: 2079957 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2516129 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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