Healthcare Provider Details

I. General information

NPI: 1033658059
Provider Name (Legal Business Name): ACCESS RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WAYNE AVE
DAYTON OH
45420-1833
US

IV. Provider business mailing address

2611 WAYNE AVE
DAYTON OH
45420-1833
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-7801
  • Fax: 937-256-7811
Mailing address:
  • Phone: 937-256-7801
  • Fax: 937-256-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number022667050
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHUMATE
Title or Position: RDO -PSI
Credential:
Phone: 440-724-7134