Healthcare Provider Details

I. General information

NPI: 1679667083
Provider Name (Legal Business Name): STEUBENVILLE PHARMACY SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/19/2008
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

500 MARKET ST STE 4
STEUBENVILLE OH
43952-2871
US

V. Phone/Fax

Practice location:
  • Phone: 740-535-1182
  • Fax: 740-535-1648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021031900
License Number StateOH

VIII. Authorized Official

Name: TERRY REED
Title or Position: COO
Credential:
Phone: 740-284-1810