Basic Information
| Provider Information | |||||||||
| NPI: | 1124310552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORRELLI | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8465 STATE ROUTE 339 | ||||||||
| Address2: | |||||||||
| City: | VINCENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457845647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406782384 | ||||||||
| FaxNumber: | 7406782962 | ||||||||
| Practice Location | |||||||||
| Address1: | 8465 STATE ROUTE 339 | ||||||||
| Address2: | |||||||||
| City: | VINCENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457845647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406782384 | ||||||||
| FaxNumber: | 7406782962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2011 | ||||||||
| LastUpdateDate: | 04/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16229 | OH | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 4423 | WV | N | Pharmacy Service Providers | Pharmacist |
No ID Information.