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General NPI Number Information
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NPI Number | 1407202914
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Entity Type | Organization
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Legal Business Name | MEDTIME PHARMACY LLC
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 400 12TH ST NW
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City | CANTON
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State | OH
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Zip | 44703-1809
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Country | US
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Telephone | 234-410-3366
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Fax | 234-410-3221
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Provider Business Mailing Address
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Address Line | 400 12TH ST NW
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City | CANTON
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State | OH
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Zip | 44703-1809
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Country | US
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Telephone | 234-410-3366
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Fax | 234-410-3221
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Authorized Official
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Title or Position | OWNER, PIC, AO
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Name | TAMER IBRAHIM
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Credential | RPH
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Telephone | 330-412-7442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PMY.022610900
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License Number State | OH
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