Provider Demographics
NPI:1760597702
Name:DONNELLY PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:DONNELLY PHARMACY SERVICES INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-286-6166
Mailing Address - Street 1:325 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1184
Mailing Address - Country:US
Mailing Address - Phone:440-286-6166
Mailing Address - Fax:440-285-4789
Practice Address - Street 1:325 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1184
Practice Address - Country:US
Practice Address - Phone:440-286-6166
Practice Address - Fax:440-285-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OH0211138003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3665304OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH2092104Medicaid
BT6162553OtherDEA
OH2092104Medicaid