Provider Demographics
NPI:1346333143
Name:RICHARD L BERRY PHARMACY INC
Entity Type:Organization
Organization Name:RICHARD L BERRY PHARMACY INC
Other - Org Name:BERRY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-921-9160
Mailing Address - Street 1:4405 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1602
Mailing Address - Country:US
Mailing Address - Phone:330-792-6585
Mailing Address - Fax:330-792-3381
Practice Address - Street 1:4405 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1602
Practice Address - Country:US
Practice Address - Phone:330-792-6585
Practice Address - Fax:330-792-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
OH0210314003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072270OtherPK
OH2028004Medicaid
OH2028004Medicaid