1588641625 NPI number — D B O INCORPORATED

Table of content: (NPI 1588641625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588641625 NPI number — D B O INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D B O INCORPORATED
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:
THE MEDICINE SHOPPE
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:
1588641625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 PILLOW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001-5619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-282-8446
Provider Business Mailing Address Fax Number:
724-282-1113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PILLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-5619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-282-8446
Provider Business Practice Location Address Fax Number:
724-282-1113
Provider Enumeration Date:
12/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OCVIRK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-282-8446

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP413643L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PP413643L . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3948758 . This is a "NABP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 190988297 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".