ZZ-PAINESVILLE CBOC PHARMACY (4185)    INSTITUTION (4)

Name Value
NAME ZZ-PAINESVILLE CBOC PHARMACY
STATE OHIO
STREET ADDR. 1 7 WEST JACKSON STREET
CITY PAINESVILLE
ZIP 44077-3210
INACTIVE FACILITY FLAG INACTIVE
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME PAINESVILLE VA CBOC PHARMACY
EFFECTIVE DATE/TIME
  • 2012-05-01 00:00:00
    STATUS:   ACTIVE
    NPI:   1891054086
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE OTHER
POINTER TO AGENCY OTHER