Provider Demographics
NPI:1801966866
Name:STATTON INC.
Entity type:Organization
Organization Name:STATTON INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETTON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-293-6358
Mailing Address - Street 1:30 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2167
Mailing Address - Country:US
Mailing Address - Phone:724-885-0310
Mailing Address - Fax:724-885-0330
Practice Address - Street 1:270 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-1087
Practice Address - Country:US
Practice Address - Phone:440-293-6358
Practice Address - Fax:440-293-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021302450333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2308041Medicaid
OH4499620001Medicare NSC