1629045976 NPI number — SKILLED CARE PHARMACY,LLC

Table of content: (NPI 1629045976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629045976 NPI number — SKILLED CARE PHARMACY,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKILLED CARE PHARMACY,LLC
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:
6
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:
1629045976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6175 HI TEK CT
Provider Second Line Business Mailing Address:
SKILLED CARE PHARMACY, LLC
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-459-7455
Provider Business Mailing Address Fax Number:
513-459-8278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9299 MARKET PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROADVIEW HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44147-2865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-765-9400
Provider Business Practice Location Address Fax Number:
800-688-1638
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALLUZZO
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-334-1624

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  022285900 , 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: 3674353 . This is a "NABP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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