Healthcare Provider Details

I. General information

NPI: 1508347451
Provider Name (Legal Business Name): DDCRX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HIGHPOINT OAKS DR
LEWISVILLE TX
75067-8215
US

IV. Provider business mailing address

8333 ROCKSIDE RD
VALLEY VIEW OH
44125
US

V. Phone/Fax

Practice location:
  • Phone: 216-369-2200
  • Fax:
Mailing address:
  • Phone: 216-369-2200
  • Fax: 216-369-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD MICHAEL DONNELLY
Title or Position: SVP COMPLIANCE
Credential:
Phone: 216-369-2200