MEDICARE: DAVID PHARMACY 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	3336C0003X	Community/Retail Pharmacy	RTP.022412050-03	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146161	OTHER		PK

General Provider Information

NPI Number	:	1588663793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID PHARMACY LLC

Provider Business Mailing Address
First Line	:	1518 E MAIN ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3435
Country	:	US
Telephone Number	:	740-304-0658
Fax Number	:	740-304-0747

Provider Business Practice Location Address
First Line	:	1518 E MAIN ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3435
Country	:	US
Telephone Number	:	740-304-0746
Fax Number	:	740-304-0747

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DUSTIN BARRETT
Credential	:
Telephone Number	:	740-304-0746

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/03/2015

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Directions to “DAVID PHARMACY LLC ” Practice Location

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