Healthcare Provider Details

I. General information

NPI: 1942034376
Provider Name (Legal Business Name): DECARIA BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 BEAVER GRADE RD
CORAOPOLIS PA
15108-2747
US

IV. Provider business mailing address

935 BEAVER GRADE RD
CORAOPOLIS PA
15108-2747
US

V. Phone/Fax

Practice location:
  • Phone: 412-264-2230
  • Fax: 412-264-9497
Mailing address:
  • Phone: 412-264-2230
  • Fax: 412-264-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MARY ANN ANDRESEN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 740-317-4282