Healthcare Provider Details

I. General information

NPI: 1437552866
Provider Name (Legal Business Name): ASHTABULA COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 LAKE AVE PHARMACY DEPARTMENT
ASHTABULA OH
44004-4954
US

IV. Provider business mailing address

2420 LAKE AVE PHARMACY DEPARTMENT
ASHTABULA OH
44004-4954
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-6276
  • Fax: 440-997-6679
Mailing address:
  • Phone: 440-997-6276
  • Fax: 440-997-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberHOS.020040800-03
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BARRY SHICK
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 440-997-6276