Provider Demographics
NPI:1932190923
Name:DANVILLE PHARMACY INC
Entity type:Organization
Organization Name:DANVILLE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEKKINEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-599-6744
Mailing Address - Street 1:10 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-0070
Mailing Address - Country:US
Mailing Address - Phone:740-599-6744
Mailing Address - Fax:740-599-6799
Practice Address - Street 1:10 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014-0070
Practice Address - Country:US
Practice Address - Phone:740-599-6744
Practice Address - Fax:740-599-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020636650333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0809790Medicaid
OH3654262OtherNCPDP NUMBER
OH0494060001Medicare UPIN