Healthcare Provider Details

I. General information

NPI: 1053322610
Provider Name (Legal Business Name): SCARBROUGH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N MAIN ST
NORTH BALTIMORE OH
45872-1124
US

IV. Provider business mailing address

127 N MAIN ST
NORTH BALTIMORE OH
45872-1124
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-2221
  • Fax: 419-257-2401
Mailing address:
  • Phone: 419-257-2221
  • Fax: 419-257-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021226250
License Number StateOH

VIII. Authorized Official

Name: DEAN SCARBROUGH
Title or Position: PRESIDENT
Credential:
Phone: 419-278-1851