Provider Demographics
NPI:1851076129
Name:HYDE DRUG, L.L.C.
Entity Type:Organization
Organization Name:HYDE DRUG, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPERO
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:724-652-1451
Mailing Address - Street 1:2412 WILMINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1939
Mailing Address - Country:US
Mailing Address - Phone:724-652-1451
Mailing Address - Fax:724-657-0592
Practice Address - Street 1:2412 WILMINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1939
Practice Address - Country:US
Practice Address - Phone:724-652-1451
Practice Address - Fax:724-657-0592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HYDE DRUG, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101031050004Medicaid