Provider Demographics
NPI:1285072603
Name:SIGNATURE HEALTH INC. PHARMACY
Entity type:Organization
Organization Name:SIGNATURE HEALTH INC. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN DRAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:216-663-6100
Mailing Address - Street 1:21100 SOUTHGATE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3004
Mailing Address - Country:US
Mailing Address - Phone:216-395-1060
Mailing Address - Fax:
Practice Address - Street 1:21100 SOUTHGATE PARK BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3004
Practice Address - Country:US
Practice Address - Phone:216-395-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336L0003X
OHCLPH0223127503336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy