Provider Demographics
NPI:1801831334
Name:PHARMACARE COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:PHARMACARE COMPOUNDING PHARMACY
Other - Org Name:PHARMACARE COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:330-633-0714
Mailing Address - Street 1:232 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2110
Mailing Address - Country:US
Mailing Address - Phone:330-633-0714
Mailing Address - Fax:330-633-0716
Practice Address - Street 1:232 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2110
Practice Address - Country:US
Practice Address - Phone:330-633-0714
Practice Address - Fax:330-633-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0221643503336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132801OtherPK