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General NPI Number Information
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NPI Number | 1689659369
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Entity Type | Organization
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Legal Business Name | FAMILY PHARMACY
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 124 S MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2052
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Country | US
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Telephone | 937-592-2826
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Fax | 937-592-0913
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Provider Business Mailing Address
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Address Line | 124 S MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2052
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Country | US
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Telephone | 937-592-2826
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Fax | 937-592-0913
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | D FRED BURTON
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Credential | RPH
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Telephone | 937-592-2826
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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 | 020759050
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License Number State | OH
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