Healthcare Provider Details

I. General information

NPI: 1851935399
Provider Name (Legal Business Name): EXCELS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SALEM AVE
DAYTON OH
45406-2750
US

IV. Provider business mailing address

2800 SALEM AVE
DAYTON OH
45406-2750
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-8700
  • Fax: 937-278-8701
Mailing address:
  • Phone: 937-278-8700
  • Fax: 937-278-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. OBIMBA ISAAC
Title or Position: PRESIDENT/OWNER
Credential: PHARMACIST
Phone: 937-572-1275