Provider Demographics
NPI:1538170170
Name:STEUBENVILLE PHARMACY SERVICE INC
Entity type:Organization
Organization Name:STEUBENVILLE PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPER OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-284-1810
Mailing Address - Street 1:100 WELDAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3779
Mailing Address - Country:US
Mailing Address - Phone:740-284-1810
Mailing Address - Fax:740-284-1814
Practice Address - Street 1:100 WELDAY AVE STE B
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3779
Practice Address - Country:US
Practice Address - Phone:740-284-1810
Practice Address - Fax:740-284-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0210218503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2032151Medicaid
WV6001270000Medicaid
2075281OtherPK
OH2032151Medicaid