MEDICARE: ADEGEN 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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1245093574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADEGEN PHARMACY LLC

Provider Business Mailing Address
First Line	:	1620 GATEWAY CIR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8650
Country	:	US
Telephone Number	:	614-522-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 GATEWAY CIR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8650
Country	:	US
Telephone Number	:	614-522-0429
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN GOSS
Credential	:
Telephone Number	:	614-522-0429

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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Directions to “ADEGEN PHARMACY LLC ” Practice Location

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