Provider Demographics
NPI:1982163853
Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Entity Type:Organization
Organization Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-424-7221
Mailing Address - Street 1:7880 LINCOLE PL
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8322
Mailing Address - Country:US
Mailing Address - Phone:330-424-7221
Mailing Address - Fax:888-270-6769
Practice Address - Street 1:16480 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9124
Practice Address - Country:US
Practice Address - Phone:330-386-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232000062OtherSTATE OF OHIO BOARD OF PHARMACY