Healthcare Provider Details

I. General information

NPI: 1710701255
Provider Name (Legal Business Name): DDCRX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HIGHPOINT OAKS DR STE 100
LEWISVILLE TX
75067-3896
US

IV. Provider business mailing address

8333 ROCKSIDE RD
CLEVELAND OH
44125-6134
US

V. Phone/Fax

Practice location:
  • Phone: 877-355-7225
  • Fax:
Mailing address:
  • Phone: 216-369-2200
  • Fax:

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