Provider Demographics
NPI:1952404279
Name:DECARIA, BRUNO A (RPH)
Entity Type:Individual
Prefix:
First Name:BRUNO
Middle Name:A
Last Name:DECARIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3031
Mailing Address - Country:US
Mailing Address - Phone:330-385-0825
Mailing Address - Fax:330-385-8415
Practice Address - Street 1:104 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3031
Practice Address - Country:US
Practice Address - Phone:330-385-0825
Practice Address - Fax:330-385-8415
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21105183500000X
WVRP0005753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist