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General NPI Number Information
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NPI Number | 1922143551
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Entity Type | Organization
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Legal Business Name | LALLY DRUG INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 23 ERIE RD
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City | TALLMADGE
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State | OH
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Zip | 44278-2326
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Country | US
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Telephone | 330-633-3239
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Fax | 330-633-0748
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Provider Business Mailing Address
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Address Line | 23 ERIE RD
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City | TALLMADGE
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State | OH
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Zip | 44278-2326
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | CHARLES LALLY
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Credential | RPH
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Telephone | 330-631-3785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02166415000510
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License Number State | OH
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