Healthcare Provider Details

I. General information

NPI: 1114021177
Provider Name (Legal Business Name): LOUISVILLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W MAIN ST
LOUISVILLE OH
44641-1338
US

IV. Provider business mailing address

2523 TUSCARAWAS ST W
CANTON OH
44708-4701
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-5525
  • Fax: 330-875-9798
Mailing address:
  • Phone: 330-453-4804
  • Fax: 330-453-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020557650
License Number StateOH

VIII. Authorized Official

Name: BRAD WHITE
Title or Position: VICE PRESIDENT
Credential: B.S
Phone: 330-339-4466