Healthcare Provider Details

I. General information

NPI: 1679212971
Provider Name (Legal Business Name): MIKE'S MEDS AND MORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STATE ST
SALEM OH
44460-2256
US

IV. Provider business mailing address

1136 E STATE ST
SALEM OH
44460-2256
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-9919
  • Fax: 330-332-2501
Mailing address:
  • Phone: 330-332-9919
  • Fax: 330-332-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PHILIP DOMBROWSKI
Title or Position: OWNER/OPERATOR
Credential: RPH
Phone: 330-332-9919