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General NPI Number Information
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NPI Number | 1669213385
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Entity Type | Organization
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Legal Business Name | MEDINA FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 3705 MEDINA RD STE C
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City | MEDINA
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State | OH
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Zip | 44256-6616
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Country | US
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Telephone | 330-486-8396
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Fax | 888-905-4906
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Provider Business Mailing Address
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Address Line | 3705 MEDINA RD STE C
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City | MEDINA
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State | OH
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Zip | 44256-6616
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Country | US
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Telephone | 330-486-8396
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Fax | 888-905-4906
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOHN KOMARA III
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Credential | PHARMD
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Telephone | 304-868-3963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 |
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License Number State |
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