=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851935399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2019
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 SALEM AVE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45406-2750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-278-8700
-----------------------------------------------------
Fax | 937-278-8701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 SALEM AVE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45406-2750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-278-8700
-----------------------------------------------------
Fax | 937-278-8701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. OBIMBA ISAAC
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 937-572-1275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------