Healthcare Provider Details

I. General information

NPI: 1396805537
Provider Name (Legal Business Name): IDEAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 GILBERT AVE
CINCINNATI OH
45206-1207
US

IV. Provider business mailing address

1840 DUCK CREEK RD APT 3
CINCINNATI OH
45207-1625
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-6665
  • Fax: 513-751-2870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAUL WENKER
Title or Position: LEGAL COUNCEL
Credential:
Phone: 513-381-9222