=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548631765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLAKER'S APOTHECARY, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2015
-----------------------------------------------------
Last Update Date | 05/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1013 JEFFERSON ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-1283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-981-3245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1013 JEFFERSON ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-1283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-981-3245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | DAVID LEE OLAKER JR.
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 937-763-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 03221196
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------