Provider Demographics
NPI:1689484511
Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Entity type:Organization
Organization Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HUDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:330-724-5471
Mailing Address - Street 1:7880 LINCOLE PL
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7880 LINCOLE PL
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8322
Practice Address - Country:US
Practice Address - Phone:330-870-1145
Practice Address - Fax:330-870-0450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232000517OtherOHIO BOARD OF PHARMACY LICENSE NUMBER