Provider Demographics
NPI:1144337817
Name:SARDINIA PHARMACY INC
Entity type:Organization
Organization Name:SARDINIA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-446-2545
Mailing Address - Street 1:7110 BACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9456
Mailing Address - Country:US
Mailing Address - Phone:937-446-2545
Mailing Address - Fax:937-446-2600
Practice Address - Street 1:7110 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-9456
Practice Address - Country:US
Practice Address - Phone:937-446-2545
Practice Address - Fax:937-446-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0761350332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0945722Medicaid
OH0787040001Medicare NSC