Provider Demographics
NPI:1316935976
Name:DECARIA BROTHERS INC
Entity type:Organization
Organization Name:DECARIA BROTHERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR OF CLINICAL SVCS
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:330-385-6339
Mailing Address - Street 1:104 E 5TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:E LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3031
Mailing Address - Country:US
Mailing Address - Phone:330-385-6339
Mailing Address - Fax:330-385-1400
Practice Address - Street 1:104 E 5TH ST # 2
Practice Address - Street 2:
Practice Address - City:E LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3031
Practice Address - Country:US
Practice Address - Phone:330-385-6339
Practice Address - Fax:330-385-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0214733003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079957OtherPK
OH2516129Medicaid