Healthcare Provider Details

I. General information

NPI: 1699763276
Provider Name (Legal Business Name): DECARIA BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CADIZ RD
WINTERSVILLE OH
43953-4126
US

IV. Provider business mailing address

503 CADIZ RD
WINTERSVILLE OH
43953-4126
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-6500
  • Fax:
Mailing address:
  • Phone: 740-264-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02-1056300
License Number StateOH

VIII. Authorized Official

Name: VINCENT B DECARIA
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 740-264-5711