Healthcare Provider Details

I. General information

NPI: 1831445048
Provider Name (Legal Business Name): DANA EADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 PARKMAN RD NW
WARREN OH
44485-1758
US

IV. Provider business mailing address

2485 PARKMAN RD NW
WARREN OH
44485-1758
US

V. Phone/Fax

Practice location:
  • Phone: 333-089-8438
  • Fax: 330-898-4526
Mailing address:
  • Phone: 333-089-8438
  • Fax: 330-898-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03230632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: