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General NPI Number Information
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NPI Number | 1700292885
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Entity Type | Organization
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Legal Business Name | MY PHARMACY OF BELLEFONTAINE,LLC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 932 E SANDUSKY AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2856
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Country | US
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Telephone | 937-441-1758
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Fax |
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Provider Business Mailing Address
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Address Line | 130 VIRGINIA DRIVE
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City | WEST LIBERTY
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State | OH
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Zip | 43357
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Country | US
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Telephone | 937-599-3408
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Fax |
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Authorized Official
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Title or Position | PIC/OWNER
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Name | MS. CARLA JEAN MURDOCK
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Credential | RPH
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Telephone | 937-441-1758
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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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