Healthcare Provider Details

I. General information

NPI: 1083700058
Provider Name (Legal Business Name): MERCY HEALTH YOUNGSTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44501
US

IV. Provider business mailing address

1044 BELMONT AVE
YOUNGSTOWN OH
44501
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-8610
  • Fax: 330-480-1469
Mailing address:
  • Phone: 330-480-8610
  • Fax: 330-480-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BARRY H SHICK
Title or Position: ADMINISTRATIVE DIRECTOR PHARMACY SE
Credential: RPH
Phone: 330-480-2587