Provider Demographics
NPI:1265577373
Name:PETRILLA INC DBA DICKS PHARMACY
Entity type:Organization
Organization Name:PETRILLA INC DBA DICKS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRILLA
Authorized Official - Suffix:I
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:330-743-3544
Mailing Address - Street 1:790 N GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44506-1078
Mailing Address - Country:US
Mailing Address - Phone:330-743-3544
Mailing Address - Fax:330-743-8106
Practice Address - Street 1:790 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44506-1078
Practice Address - Country:US
Practice Address - Phone:330-743-3544
Practice Address - Fax:330-743-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty