Provider Demographics
NPI:1053322610
Name:SCARBROUGH PHARMACY INC
Entity Type:Organization
Organization Name:SCARBROUGH PHARMACY INC
Other - Org Name:SCARBROUGH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-278-1851
Mailing Address - Street 1:127 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:45872-1124
Mailing Address - Country:US
Mailing Address - Phone:419-257-2221
Mailing Address - Fax:419-257-2401
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-1124
Practice Address - Country:US
Practice Address - Phone:419-257-2221
Practice Address - Fax:419-257-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0212262503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3607504OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH2186521Medicaid
0739740003Medicare NSC