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General NPI Number Information
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NPI Number | 1316935976
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Entity Type | Organization
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Legal Business Name | DECARIA BROTHERS INC
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 104 E 5TH ST # 2
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City | E LIVERPOOL
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State | OH
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Zip | 43920-3031
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Country | US
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Telephone | 330-385-6339
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Fax | 330-385-1400
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Provider Business Mailing Address
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Address Line | 104 E 5TH ST # 2
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City | E LIVERPOOL
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State | OH
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Zip | 43920-3031
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Country | US
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Telephone | 330-385-6339
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Fax | 330-385-1400
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Authorized Official
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Title or Position | DIR OF CLINICAL SVCS
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Name | ERIN MADER
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Credential | PHARMD
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Telephone | 330-385-6339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 021473300
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License Number State | OH
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