Healthcare Provider Details

I. General information

NPI: 1205385333
Provider Name (Legal Business Name): UPTOWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SPORTSMAN DR SUITE B
MARENGO OH
43334-1800
US

IV. Provider business mailing address

73 SPORTSMAN DR SUITE B
MARENGO OH
43334-1800
US

V. Phone/Fax

Practice location:
  • Phone: 419-253-0632
  • Fax: 419-253-0622
Mailing address:
  • Phone: 419-253-0632
  • Fax: 419-253-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number022629350
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number022629350
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022629350
License Number StateOH

VIII. Authorized Official

Name: DR. NICHOLAS WILLIAM NEWMAN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 419-253-0732