Provider Demographics
NPI:1700958592
Name:S & S PHARMACY INC
Entity Type:Organization
Organization Name:S & S PHARMACY INC
Other - Org Name:SPEIDELS MEDICAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-296-6014
Mailing Address - Street 1:6693 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3922
Mailing Address - Country:US
Mailing Address - Phone:330-296-6014
Mailing Address - Fax:330-296-6100
Practice Address - Street 1:6693 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3922
Practice Address - Country:US
Practice Address - Phone:330-296-6014
Practice Address - Fax:330-296-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OH0206036503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0578129Medicaid
3643384OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0786790001Medicare NSC