Provider Demographics
NPI:1588641625
Name:D B O INCORPORATED
Entity Type:Organization
Organization Name:D B O INCORPORATED
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:OCVIRK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-282-8446
Mailing Address - Street 1:125 PILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5619
Mailing Address - Country:US
Mailing Address - Phone:724-282-8446
Mailing Address - Fax:724-282-1113
Practice Address - Street 1:125 PILLOW ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5619
Practice Address - Country:US
Practice Address - Phone:724-282-8446
Practice Address - Fax:724-282-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413643L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP413643LOtherSTATE LICENSE
PA3948758OtherNABP
PA190988297Medicaid
PA190988297Medicaid
PA0418480001Medicare NSC