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General NPI Number Information
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NPI Number | 1801966866
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Entity Type | Organization
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Legal Business Name | STATTON INC.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 270 EAST MAIN ST.
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City | ANDOVER
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State | OH
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Zip | 44003-1087
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Country | US
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Telephone | 440-293-6358
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Fax | 440-293-7251
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Provider Business Mailing Address
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Address Line | 30 CONNEAUT LAKE RD
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City | GREENVILLE
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State | PA
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Zip | 16125-2167
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Country | US
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Telephone | 724-885-0310
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Fax | 724-885-0330
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRETTON CLARK WALBERG
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Credential | RPH
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Telephone | 440-293-6358
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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 | 021302450
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License Number State | OH
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