Healthcare Provider Details

I. General information

NPI: 1821695594
Provider Name (Legal Business Name): SIGNATURE HEALTH INC. PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S SAINT CLAIR ST
PAINESVILLE OH
44077-3418
US

IV. Provider business mailing address

53 S SAINT CLAIR ST
PAINESVILLE OH
44077-3418
US

V. Phone/Fax

Practice location:
  • Phone: 440-853-1225
  • Fax: 440-853-1134
Mailing address:
  • Phone: 440-578-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLEY S DRAGAR
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 440-578-8200