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General NPI Number Information
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NPI Number | 1942690698
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Entity Type | Organization
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Legal Business Name | ADENA PHARMACY LLC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 100 DAWN LN
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City | WAVERLY
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State | OH
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Zip | 45690-9138
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Country | US
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Telephone | 740-947-6320
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Fax | 740-947-6301
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Provider Business Mailing Address
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Address Line | 100 DAWN LN
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City | WAVERLY
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State | OH
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Zip | 45690-9138
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Country | US
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Telephone | 740-947-6376
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT PHARMACY MANAGER
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Name | MICHAEL JOHNSON
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Credential |
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Telephone | 740-779-8761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RTPC.022492650-03
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License Number State | OH
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