MEDICARE: CINCINNATI PHARMACY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0004X	Compounding Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1437615440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINCINNATI PHARMACY LLC

Provider Business Mailing Address
First Line	:	3495 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2876
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3495 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2876
Country	:	US
Telephone Number	:	513-376-5358
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	TAREK MOHAMED
Credential	:
Telephone Number	:	513-376-5358

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/14/2019

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Directions to “CINCINNATI PHARMACY LLC ” Practice Location

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