Provider Demographics
NPI:1902822232
Name:BRIAR HILL FOODS
Entity Type:Organization
Organization Name:BRIAR HILL FOODS
Other - Org Name:THORNES IGA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-332-0021
Mailing Address - Street 1:501 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1029
Practice Address - Country:US
Practice Address - Phone:330-627-4521
Practice Address - Fax:330-627-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2426422Medicaid
3671751OtherOTHER ID NUMBER
OH2426422Medicaid