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General NPI Number Information
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NPI Number | 1245986694
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Entity Type | Organization
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Legal Business Name | PROMEDICA PHARMACY GROUP LLC
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 3142 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-2920
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Country | US
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Telephone | 419-291-4496
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Fax |
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Provider Business Mailing Address
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Address Line | 3142 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-2920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | DR. BRYAN COEHRS
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Credential | PHARMD RPH
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Telephone | 567-585-3041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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