Healthcare Provider Details

I. General information

NPI: 1013072388
Provider Name (Legal Business Name): PACKS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 MADISON RD
CINCINNATI OH
45208-3221
US

IV. Provider business mailing address

2114 MADISON RD
CINCINNATI OH
45208-3221
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-7770
  • Fax: 513-871-0492
Mailing address:
  • Phone: 513-871-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020079850
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FORREST PACK
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 513-871-7770