Healthcare Provider Details

I. General information

NPI: 1174686794
Provider Name (Legal Business Name): VIENNA PHARMACY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 YOUNGSTOWN KINGSVILLE RD SE
VIENNA OH
44473-9601
US

IV. Provider business mailing address

347 YOUNGSTOWN KINGSVILLE RD SE
VIENNA OH
44473-9601
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-3429
  • Fax: 330-856-9637
Mailing address:
  • Phone: 330-856-3429
  • Fax: 330-856-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRTP02163665003
License Number StateOH

VIII. Authorized Official

Name: JENNNIFER WEARSCH
Title or Position: OWNER, PIC, AO
Credential: RPH
Phone: 330-856-3429