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General NPI Number Information
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NPI Number | 1326320557
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Entity Type | Organization
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Legal Business Name | ADENA PHARMACY, LLC
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 4439 STATE ROUTE 159 SUITE G40
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-8207
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Country | US
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Telephone | 740-779-8763
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Fax | 740-779-8769
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Provider Business Mailing Address
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Address Line | 4439 STATE ROUTE 159 SUITE G40
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-8207
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Country | US
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Telephone | 740-779-8763
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Fax | 740-779-8769
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Authorized Official
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Title or Position | ASS. PHARMACY DIRECTOR
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Name | JOHN KNISLEY
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Credential |
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Telephone | 740-779-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 022135850
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License Number State | OH
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