MEDICARE: PELPHREYS PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1013507102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELPHREYS PHARMACY LLC

Provider Business Mailing Address
First Line	:	7208 TAYLORSVILLE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2303
Country	:	US
Telephone Number	:	937-813-1301
Fax Number	:	937-813-1332

Provider Business Practice Location Address
First Line	:	7208 TAYLORSVILLE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2303
Country	:	US
Telephone Number	:	937-813-1301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA BRASHEARS PELPHREY
Credential	:
Telephone Number	:	937-813-1301

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	04/08/2021

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