=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245324482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD L BERRY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6900 MARKET ST
-----------------------------------------------------
City | BOARDMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-729-9710
-----------------------------------------------------
Fax | 330-729-9715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6900 MARKET ST
-----------------------------------------------------
City | BOARDMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-729-9710
-----------------------------------------------------
Fax | 330-729-9715
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RICHARD L BERRY
-----------------------------------------------------
Credential | R.P.H
-----------------------------------------------------
Telephone | 330-729-9710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 02-1244650
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 021244650
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------