Basic Information
Provider Information | |||||||||
NPI: | 1871973966 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CAREEQUIP, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NORTHSIDE MVHC PHARMACY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 133 N MAYSVILLE AVE | ||||||||
Address2: |   | ||||||||
City: | ZANESVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 437016112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7404545666 | ||||||||
FaxNumber: | 7404527563 | ||||||||
Practice Location | |||||||||
Address1: | 716 ADAIR AVE | ||||||||
Address2: |   | ||||||||
City: | ZANESVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 43701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7408688171 | ||||||||
FaxNumber: | 7408688186 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2015 | ||||||||
LastUpdateDate: | 04/25/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STOEPFEL | ||||||||
AuthorizedOfficialFirstName: | EDWARD | ||||||||
AuthorizedOfficialMiddleName: | JAY | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7404545666 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | CARE EQUIP, LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RPH | ||||||||
NPICertificationDate: | 04/25/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 022514800 | OH | Y |   | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
ID | Type | State | Issuer | Description | 022514800 | 01 | OH | STATE BOARD OF PHARMACY | OTHER | 0133461 | 05 | OH |   | MEDICAID |