Healthcare Provider Details

I. General information

NPI: 1437615440
Provider Name (Legal Business Name): CINCINNATI PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BURNET AVE
CINCINNATI OH
45229-2876
US

IV. Provider business mailing address

3495 BURNET AVE
CINCINNATI OH
45229-2876
US

V. Phone/Fax

Practice location:
  • Phone: 513-376-5358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAREK MOHAMED
Title or Position: OWNER/MANAGER
Credential:
Phone: 513-376-5358