Healthcare Provider Details

I. General information

NPI: 1073822870
Provider Name (Legal Business Name): FAMILY MED-MART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 208
COLUMBUS OH
43214-1876
US

IV. Provider business mailing address

2833 BRYN MAWR DR
LEWIS CENTER OH
43035-8915
US

V. Phone/Fax

Practice location:
  • Phone: 614-547-7766
  • Fax: 614-547-7742
Mailing address:
  • Phone: 614-598-3001
  • Fax: 614-547-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022659650
License Number StateOH

VIII. Authorized Official

Name: YAMROTE LAKEW
Title or Position: MANAGING MEMBER/AGENT
Credential:
Phone: 614-598-3001