Provider Demographics
NPI:1336735901
Name:PHARMCO MANAGEMENT, LLC
Entity Type:Organization
Organization Name:PHARMCO MANAGEMENT, LLC
Other - Org Name:COMPOUNDING PHARMACY OF GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:330-899-0406
Mailing Address - Street 1:877 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9282
Mailing Address - Country:US
Mailing Address - Phone:330-232-1255
Mailing Address - Fax:330-899-0652
Practice Address - Street 1:4016 MASSILLON RD STE B
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7818
Practice Address - Country:US
Practice Address - Phone:330-899-0406
Practice Address - Fax:330-899-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336735901OtherNPI
OH0232000218OtherLICENSE TO DISTRIBUTE DANGEROUS DRUGS
OH0426880Medicaid
3688554OtherNCPDP
1336735901OtherNPI