MEDICARE: EXCELS 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
2	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851935399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELS PHARMACY LLC

Provider Business Mailing Address
First Line	:	2800 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2750
Country	:	US
Telephone Number	:	937-278-8700
Fax Number	:	937-278-8701

Provider Business Practice Location Address
First Line	:	2800 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2750
Country	:	US
Telephone Number	:	937-278-8700
Fax Number	:	937-278-8701

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. OBIMBA ISAAC
Credential	:	PHARMACIST
Telephone Number	:	937-572-1275

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	05/09/2022

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