Healthcare Provider Details

I. General information

NPI: 1285072603
Provider Name (Legal Business Name): SIGNATURE HEALTH INC. PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21100 SOUTHGATE PARK BLVD
MAPLE HEIGHTS OH
44137-3004
US

IV. Provider business mailing address

21100 SOUTHGATE PARK BLVD
MAPLE HEIGHTS OH
44137-3004
US

V. Phone/Fax

Practice location:
  • Phone: 216-395-1060
  • Fax:
Mailing address:
  • Phone: 216-395-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberCLPH022312750
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLEY S DRAGAR
Title or Position: CHIEF PHARMACY OFFICER
Credential: PHARM D.
Phone: 216-663-6100