Provider Demographics
NPI:1285631069
Name:FORUM HEALTH PHARMACY SERVICES CO., INC.
Entity Type:Organization
Organization Name:FORUM HEALTH PHARMACY SERVICES CO., INC.
Other - Org Name:DACAS HOME THERAPIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-841-1066
Mailing Address - Street 1:1915 BELMONT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1132
Mailing Address - Country:US
Mailing Address - Phone:330-884-2190
Mailing Address - Fax:330-884-2636
Practice Address - Street 1:1915 BELMONT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1132
Practice Address - Country:US
Practice Address - Phone:330-884-2190
Practice Address - Fax:330-884-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251F00000X, 332BP3500X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251F00000XAgenciesHome Infusion
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237274Medicaid
OH000000155815OtherBCBS - ANTHEM PROVIDER N
OH20579OtherINS. PROVIDER # - QUAL CH
OH=========-00OtherWORKERS COMP PROVIDER #
OH0237274Medicaid