MEDICARE: MR PRESCRIPTION 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	02731100	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3657939	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1922107481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR PRESCRIPTION INC

Provider Business Mailing Address
First Line	:	7044 SOLUTION CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0001
Country	:	US
Telephone Number	:	937-428-7970
Fax Number	:	937-428-7978

Provider Business Practice Location Address
First Line	:	6149 FAR HILLS AVE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1925
Country	:	US
Telephone Number	:	937-433-6669
Fax Number	:	937-433-6659

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIM CLARK
Credential	:
Telephone Number	:	937-428-7970

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/29/2011

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Directions to “MR PRESCRIPTION INC ” Practice Location

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