Healthcare Provider Details

I. General information

NPI: 1134118854
Provider Name (Legal Business Name): SALEM PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SALEM AVE
DAYTON OH
45406-5144
US

IV. Provider business mailing address

1100 SALEM AVE
DAYTON OH
45406-5144
US

V. Phone/Fax

Practice location:
  • Phone: 937-276-2173
  • Fax: 937-276-2174
Mailing address:
  • Phone: 937-276-2173
  • Fax: 937-276-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN P RYAN
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 937-276-2173