Healthcare Provider Details

I. General information

NPI: 1952404279
Provider Name (Legal Business Name): BRUNO A DECARIA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 5TH ST
EAST LIVERPOOL OH
43920-3031
US

IV. Provider business mailing address

104 E 5TH ST
EAST LIVERPOOL OH
43920-3031
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-0825
  • Fax: 330-385-8415
Mailing address:
  • Phone: 330-385-0825
  • Fax: 330-385-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-21105
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0005753
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: