Provider Demographics
NPI:1699763276
Name:DECARIA BROTHERS INC
Entity type:Organization
Organization Name:DECARIA BROTHERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DECARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-264-5711
Mailing Address - Street 1:503 CADIZ RD
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-4126
Mailing Address - Country:US
Mailing Address - Phone:740-264-6500
Mailing Address - Fax:
Practice Address - Street 1:503 CADIZ RD
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-4126
Practice Address - Country:US
Practice Address - Phone:740-264-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1056300333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8500539Medicaid
3664883OtherNABP
OH2049081Medicaid
BD5733236OtherDEA
OH2049081Medicaid