Healthcare Provider Details

I. General information

NPI: 1841632684
Provider Name (Legal Business Name): PHARMASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MCLISTER AVE
MINGO JUNCTION OH
43938-1259
US

IV. Provider business mailing address

116 MCLISTER AVE
MINGO JUNCTION OH
43938-1259
US

V. Phone/Fax

Practice location:
  • Phone: 740-535-8068
  • Fax: 740-535-8079
Mailing address:
  • Phone: 740-535-8068
  • Fax: 740-535-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41.15573-SA
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number45.15573-SA
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.387475
License Number StateOH

VIII. Authorized Official

Name: MR. FRANK VOSTATEK
Title or Position: OWNER
Credential: BSPHARM,RPH,BSN,RN
Phone: 740-535-8068