Provider Demographics
NPI:1528144813
Name:SYLVANIA PHARMACY LIMITED
Entity type:Organization
Organization Name:SYLVANIA PHARMACY LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:DOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-842-1531
Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:STE C1
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9740
Mailing Address - Country:US
Mailing Address - Phone:419-842-1531
Mailing Address - Fax:419-842-1532
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:STE C1
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9740
Practice Address - Country:US
Practice Address - Phone:419-842-1531
Practice Address - Fax:419-842-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0214543503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5317870001Medicare NSC