Provider Demographics
NPI:1114962701
Name:SHRIVERS PHARMACY ELDERCARE SOLUTIONS, INC
Entity Type:Organization
Organization Name:SHRIVERS PHARMACY ELDERCARE SOLUTIONS, INC
Other - Org Name:ELDERCARE SOLUTIONS SHRIVERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-854-6800
Mailing Address - Street 1:10870 PORTAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8817
Mailing Address - Country:US
Mailing Address - Phone:330-854-6800
Mailing Address - Fax:330-854-6832
Practice Address - Street 1:10870 PORTAGE ST NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8817
Practice Address - Country:US
Practice Address - Phone:330-854-6800
Practice Address - Fax:330-854-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBS189550OtherDEA
OHBS189550OtherDEA