MEDICARE: CLINICAL PHARMACY SERVICES, 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		OH

General Provider Information

NPI Number	:	1205010618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL PHARMACY SERVICES, LLC

Provider Business Mailing Address
First Line	:	50A CENTER ST
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-7826
Country	:	US
Telephone Number	:	740-259-2442
Fax Number	:	740-259-9341

Provider Business Practice Location Address
First Line	:	50A CENTER ST
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-7826
Country	:	US
Telephone Number	:	740-259-2442
Fax Number	:	740-259-9341

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMY JANNEY
Credential	:	RPH
Telephone Number	:	740-259-2442

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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