Provider Demographics
NPI:1609864289
Name:DECARIA BROTHERS INC
Entity Type:Organization
Organization Name:DECARIA BROTHERS INC
Other - Org Name:A & B SUNSET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DECARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-385-0825
Mailing Address - Street 1:4201 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3617
Mailing Address - Country:US
Mailing Address - Phone:740-264-5711
Mailing Address - Fax:
Practice Address - Street 1:4201 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3617
Practice Address - Country:US
Practice Address - Phone:740-264-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0714902333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3639551OtherNABP
WV0140503000Medicaid
OH0647527Medicaid
BA0714902OtherDEA
WV0140503000Medicaid