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General NPI Number Information
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NPI Number | 1831191139
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Entity Type | Organization
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Legal Business Name | STAKER'S SERVICE DRUGS,INC
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 826 CHILLICOTHE ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4028
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Country | US
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Telephone | 740-353-1135
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Fax | 740-353-4109
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Provider Business Mailing Address
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Address Line | 826 CHILLICOTHE ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4028
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Country | US
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Telephone | 740-353-1135
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Fax | 740-353-4109
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD THOMAS STAKER
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Credential |
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Telephone | 740-353-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 020113850
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License Number State | OH
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