Provider Demographics
NPI:1356561427
Name:DECARIA BROTHERS INC.
Entity type:Organization
Organization Name:DECARIA BROTHERS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DECARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-382-7726
Mailing Address - Street 1:15549 STE RTE 170 STE 1
Mailing Address - Street 2:BUCKEYE PHARMACY
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920
Mailing Address - Country:US
Mailing Address - Phone:330-382-7726
Mailing Address - Fax:330-382-7728
Practice Address - Street 1:15549 STE RTE 170 STE 1
Practice Address - Street 2:BUCKEYE PHARMACY
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920
Practice Address - Country:US
Practice Address - Phone:330-382-7726
Practice Address - Fax:330-382-7728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECARIA BROTHERS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-30
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1815800332B00000X, 3336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02-1815800OtherOHIO STATE LICENSE
WV3810009042Medicaid
OH2813978Medicaid
WV3810009042Medicaid