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General NPI Number Information
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NPI Number | 1770216806
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Entity Type | Organization
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Legal Business Name | MEDX LTC PHARMACY LLC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 3021 NAVARRE AVE SUITE A
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City | OREGON
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State | OH
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Zip | 43616
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Country | US
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Telephone | 419-214-9066
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Fax |
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Provider Business Mailing Address
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Address Line | 3021 NAVARRE AVE SUITE A
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City | OREGON
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State | OH
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Zip | 43616
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Country | US
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Telephone | 419-214-9066
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Fax |
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Authorized Official
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Title or Position | RPH/OWNER
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Name | IMAD MOURAD
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Credential |
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Telephone | 419-214-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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