Healthcare Provider Details

I. General information

NPI: 1245324482
Provider Name (Legal Business Name): RICHARD L BERRY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 MARKET ST
BOARDMAN OH
44512-4505
US

IV. Provider business mailing address

6900 MARKET ST
BOARDMAN OH
44512-4505
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-9710
  • Fax: 330-729-9715
Mailing address:
  • Phone: 330-729-9710
  • Fax: 330-729-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02-1244650
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021244650
License Number StateOH

VIII. Authorized Official

Name: MR. RICHARD L BERRY
Title or Position: OWNER
Credential: R.P.H
Phone: 330-729-9710