Provider Demographics
NPI:1821695594
Name:SIGNATURE HEALTH INC. PHARMACY
Entity Type:Organization
Organization Name:SIGNATURE HEALTH INC. PHARMACY
Other - Org Name:SIGNATURE HEALTH, INC. CENTRAL FILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN DRAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-953-9999
Mailing Address - Street 1:7232 JUSTIN WAY
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4881
Mailing Address - Country:US
Mailing Address - Phone:440-953-9999
Mailing Address - Fax:
Practice Address - Street 1:53 S SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3418
Practice Address - Country:US
Practice Address - Phone:440-853-1225
Practice Address - Fax:440-853-1134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-06
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy