Provider Demographics
NPI:1467467068
Name:PIPAK ENTERPRISE
Entity Type:Organization
Organization Name:PIPAK ENTERPRISE
Other - Org Name:PIPAK ENTERPRISES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-782-8101
Mailing Address - Street 1:5106 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2107
Mailing Address - Country:US
Mailing Address - Phone:330-782-8101
Mailing Address - Fax:330-782-7744
Practice Address - Street 1:5106 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2107
Practice Address - Country:US
Practice Address - Phone:330-782-8101
Practice Address - Fax:330-782-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0208750003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2075149OtherPK
OH0186750Medicaid
2075149OtherPK