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General NPI Number Information
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NPI Number | 1508453077
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE WELLNESS PHARMACY LLC
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 7640 SYLVANIA AVE STE C-1
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City | SYLVANIA
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State | OH
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Zip | 43560-9263
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Country | US
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Telephone | 419-749-3193
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Fax | 419-299-0030
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Provider Business Mailing Address
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Address Line | 7640 SYLVANIA AVE STE C-1
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City | SYLVANIA
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State | OH
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Zip | 43560-9263
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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 | PHARMACIST IN CHARGE
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Name | HUSSEIN HAIDAR
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Credential | PHARMD
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Telephone | 419-540-9988
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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 |
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License Number State |
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