Healthcare Provider Details

I. General information

NPI: 1487043154
Provider Name (Legal Business Name): FOREVER INK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 ROBINS TRCE
AKRON OH
44319-3885
US

IV. Provider business mailing address

3257 ROBINS TRCE
AKRON OH
44319-3885
US

V. Phone/Fax

Practice location:
  • Phone: 330-283-4645
  • Fax:
Mailing address:
  • Phone: 330-283-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1538557970
License Number StateOH

VIII. Authorized Official

Name: DENISE GEORGE
Title or Position: SPECIALIST
Credential:
Phone: 330-283-4645