Healthcare Provider Details

I. General information

NPI: 1619766888
Provider Name (Legal Business Name): ZIKS FAMILY PHARMACY INC 100
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W 3RD ST
DAYTON OH
45402-6812
US

IV. Provider business mailing address

1130 W 3RD ST
DAYTON OH
45402-6812
US

V. Phone/Fax

Practice location:
  • Phone: 937-225-9350
  • Fax: 937-225-9355
Mailing address:
  • Phone: 937-225-9350
  • Fax: 937-225-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NNODUM IHEME
Title or Position: PRESIDENT
Credential: R.PH
Phone: 513-739-6293