Healthcare Provider Details

I. General information

NPI: 1245093574
Provider Name (Legal Business Name): ADEGEN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 GATEWAY CIR
GROVE CITY OH
43123-8650
US

IV. Provider business mailing address

1620 GATEWAY CIR
GROVE CITY OH
43123-8650
US

V. Phone/Fax

Practice location:
  • Phone: 614-522-0429
  • Fax:
Mailing address:
  • Phone: 614-522-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN GOSS
Title or Position: CEO
Credential:
Phone: 614-522-0429