Healthcare Provider Details

I. General information

NPI: 1548094394
Provider Name (Legal Business Name): PROMED DISCOUNT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6729 PROVIDENCE ST
WHITEHOUSE OH
43571-1011
US

IV. Provider business mailing address

8734 BIRCHFIELD RD
SYLVANIA OH
43560-9049
US

V. Phone/Fax

Practice location:
  • Phone: 419-764-5312
  • Fax:
Mailing address:
  • Phone: 419-921-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TASNEEM SHBAT
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 419-921-2944