Provider Demographics
NPI:1336276807
Name:JOSEPH ZELEK
Entity Type:Organization
Organization Name:JOSEPH ZELEK
Other - Org Name:DILLONVALE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:740-769-7332
Mailing Address - Street 1:74 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DILLONVALE
Mailing Address - State:OH
Mailing Address - Zip Code:43917-7890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:DILLONVALE
Practice Address - State:OH
Practice Address - Zip Code:43917-7890
Practice Address - Country:US
Practice Address - Phone:740-769-7332
Practice Address - Fax:740-769-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020164000333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9207937Medicaid
3636973OtherOTHER ID NUMBER
OH1232400001Medicare NSC