MEDICARE: LONDON APOTHECARY INC

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	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	020561550	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3650531	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225112352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONDON APOTHECARY INC

Provider Business Mailing Address
First Line	:	54 W HIGH ST
Second Line	:	STE A
City	:	LONDON
State	:	OH
Zip	:	43140-1075
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 W HIGH ST
Second Line	:	STE A
City	:	LONDON
State	:	OH
Zip	:	43140-1075
Country	:	US
Telephone Number	:	740-852-5131
Fax Number	:	740-852-5135

Authorized Official
Title or Position	:	OWNER
Name	:	ERNEST SPARKS
Credential	:	RPH
Telephone Number	:	740-852-5131

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/25/2014

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