Provider Demographics
NPI:1164568770
Name:DECARIA BROTHERS INC
Entity Type:Organization
Organization Name:DECARIA BROTHERS INC
Other - Org Name:PORTERS PRESCRIPTION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DECARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:412-264-2230
Mailing Address - Street 1:935 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2790
Mailing Address - Country:US
Mailing Address - Phone:412-264-2230
Mailing Address - Fax:412-264-9497
Practice Address - Street 1:935 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2790
Practice Address - Country:US
Practice Address - Phone:412-264-2230
Practice Address - Fax:412-264-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411899L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007478400003Medicaid
2080179OtherPK
4360880008OtherPTAN