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General NPI Number Information
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NPI Number | 1972651933
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Entity Type | Organization
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Legal Business Name | BETHANN PASSARELLO INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 6615 CLINGAN RD STE B
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City | POLAND
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State | OH
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Zip | 44514-2196
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Country | US
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Telephone | 330-757-3553
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Fax | 330-757-0155
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Provider Business Mailing Address
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Address Line | 6615 CLINGAN RD STE B
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City | POLAND
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State | OH
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Zip | 44514-2196
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Country | US
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Telephone | 330-757-3553
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Fax | 330-757-0155
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Authorized Official
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Title or Position | OWNER AND PHARMACIST
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Name | BETHANN PASSARELLO
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Credential | BS IN PHARMACY
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Telephone | 330-757-3553
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RTP.021352850-03
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License Number State | OH
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