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NPI Code Detail

MEDICARE: DAVES SUPERMARKET INC

MEDICARE: DAVES SUPERMARKET INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy02-0748900OH

General Provider Information

NPI Number : 1801819792
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVES SUPERMARKET INC
Provider Business Mailing Address
First Line : 3565 RIDGE RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-5443
Country : US
Telephone Number : 216-961-2005
Fax Number : 216-631-1544
Provider Business Practice Location Address
First Line : 3565 RIDGE RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-5443
Country : US
Telephone Number : 216-961-2005
Fax Number : 216-631-1544
Authorized Official
Title or Position : PHARMACY MANAGER
Name : MR. DENNIS J ELLER
Credential : RPH
Telephone Number : 216-961-2005
Provider Enumeration Date : 07/25/2006
Last Update Date : 06/18/2008

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Directions to “DAVES SUPERMARKET INC ” Practice Location

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