MEDICARE: FAMILY MED-MART LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	022659650	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2127361	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073822870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MED-MART LLC

Provider Business Mailing Address
First Line	:	2833 BRYN MAWR DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-8915
Country	:	US
Telephone Number	:	614-598-3001
Fax Number	:	614-547-7742

Provider Business Practice Location Address
First Line	:	4770 INDIANOLA AVE STE 208
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1876
Country	:	US
Telephone Number	:	614-547-7766
Fax Number	:	614-547-7742

Authorized Official
Title or Position	:	MANAGING MEMBER/AGENT
Name	:	YAMROTE LAKEW
Credential	:
Telephone Number	:	614-598-3001

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	03/29/2017

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Directions to “FAMILY MED-MART LLC ” Practice Location

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