Healthcare Provider Details

I. General information

NPI: 1104337799
Provider Name (Legal Business Name): PHARMACY COUNTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 EVERETT RD STE 2
FREMONT OH
43420-1432
US

IV. Provider business mailing address

2655 W CENTRAL AVE
TOLEDO OH
43606-3550
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-6931
  • Fax: 419-332-6044
Mailing address:
  • Phone: 419-473-1493
  • Fax: 419-474-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MISSY CROSS
Title or Position: GENERAL MANAGER
Credential:
Phone: 419-473-1473