Provider Demographics
NPI:1710284245
Name:PHYSICIANS PHARMACY LLC
Entity Type:Organization
Organization Name:PHYSICIANS PHARMACY LLC
Other - Org Name:PHYSICIANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CASERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-402-2944
Mailing Address - Street 1:727 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8052
Mailing Address - Country:US
Mailing Address - Phone:740-443-6060
Mailing Address - Fax:740-443-6042
Practice Address - Street 1:727 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8052
Practice Address - Country:US
Practice Address - Phone:740-443-6060
Practice Address - Fax:740-443-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0221006503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3679555OtherNCPDP PROVIDER IDENTIFICATION NUMBER