Healthcare Provider Details

I. General information

NPI: 1497045116
Provider Name (Legal Business Name): JOHN DENNIS MEDVEC JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 MCCARTNEY ROAD
YOUNGSTOWN OH
44505
US

IV. Provider business mailing address

693 MCCARTNEY RD
YOUNGSTOWN OH
44505-5016
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-2426
  • Fax: 330-747-1225
Mailing address:
  • Phone: 330-747-2426
  • Fax: 330-747-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-20565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: