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General NPI Number Information
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NPI Number | 1245306901
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Entity Type | Organization
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Legal Business Name | SUGARCREEK PLAZA FOODS LLC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 6134 WILMINGTON PIKE
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City | CENTERVILLE
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State | OH
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Zip | 45459-7029
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Country | US
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Telephone | 937-848-6691
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Fax | 937-848-3666
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Provider Business Mailing Address
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Address Line | 6134 WASHINGTON PIKE
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-848-4600
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Fax | 937-848-3666
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE LOFINO
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Credential | RPH
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Telephone | 937-431-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RTP020940850
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License Number State | OH
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