Organization
P & R HOME IV SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN SUE FARRIS (SECRETARY TREASURER)
(419) 587-3349
Entity
Organization
Contact information
Practice address
16937 DEFIANCE TRAIL, VAN WERT, OH 45891
(800) 587-7670
(419) 587-3229
Mailing address
16937 DEFIANCE TRAIL, VAN WERT, OH 45891
(800) 587-7670
(419) 587-3229
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
02434900
OH
3336C0003X
Community/Retail Pharmacy
Primary
02434900
OH
3336C0004X
Compounding Pharmacy
02434900
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000155895
ANTHEM DME
OH
01
—
000000224193
ANTHEM IV
OH
05
—
0631301
—
OH
01
—
340835023003
MEDICAL MUTUAL OF OHIODME
OH
01
—
53234
NORTHWOOD NPN
OH
Enumeration date
01/15/2009
Last updated
01/21/2009
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