=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689758849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C & R PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 N DETROIT ST
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-650-3333
-----------------------------------------------------
Fax | 937-650-3335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 N DETROIT ST PO BOX 761
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-650-3333
-----------------------------------------------------
Fax | 937-650-3335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CURTIS G ROACH
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 937-650-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 02-1345250
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------