Provider Demographics
NPI:1518410869
Name:THE METROHEALTH SYSTEM
Entity Type:Organization
Organization Name:THE METROHEALTH SYSTEM
Other - Org Name:METROHEALTH BRECKSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR, RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PISANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-778-3362
Mailing Address - Street 1:9200 TREEWORTH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141
Mailing Address - Country:US
Mailing Address - Phone:216-957-9050
Mailing Address - Fax:216-957-9191
Practice Address - Street 1:9200 TREEWORTH BOULEVARD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141
Practice Address - Country:US
Practice Address - Phone:216-957-9050
Practice Address - Fax:216-957-9191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE METROHEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRTP022630350033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162369OtherPK