Provider Demographics
NPI:1659534360
Name:LSVAMC PHARMACY
Entity Type:Organization
Organization Name:LSVAMC PHARMACY
Other - Org Name:VETERANS ADMINISTRATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:216-791-3800
Mailing Address - Street 1:10000 BRECKSVILLE RD
Mailing Address - Street 2:PHARMACY SERVICE 119B
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3204
Mailing Address - Country:US
Mailing Address - Phone:440-526-3030
Mailing Address - Fax:440-546-2734
Practice Address - Street 1:10000 BRECKSVILLE RD
Practice Address - Street 2:PHARMACY SERVICE 119B
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3204
Practice Address - Country:US
Practice Address - Phone:440-526-3030
Practice Address - Fax:440-546-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03 2 12788261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care