Healthcare Provider Details

I. General information

NPI: 1336476308
Provider Name (Legal Business Name): ZIKS FAMILY PHARMACY INC 102
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 07/11/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W 3RD ST
DAYTON OH
45402-6834
US

IV. Provider business mailing address

1130 W 3RD ST
DAYTON OH
45402-6812
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-9457
  • Fax: 937-275-5703
Mailing address:
  • Phone: 937-278-9457
  • Fax: 937-275-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021990900
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NNODUM IHEME
Title or Position: OWNER
Credential:
Phone: 937-278-9457