Provider Demographics
NPI:1831445048
Name:EADE, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:EADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 PARKMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-1758
Mailing Address - Country:US
Mailing Address - Phone:333-089-8438
Mailing Address - Fax:330-898-4526
Practice Address - Street 1:2485 PARKMAN RD NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-1758
Practice Address - Country:US
Practice Address - Phone:333-089-8438
Practice Address - Fax:330-898-4526
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist