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MADISON AVENUE PHARMACY INC NPI 1407930530


NPI Information

NPI: 1407930530
Provider Name: MADISON AVENUE PHARMACY INC

Doing Business As: MADISON AVENUE PHARMACY INC

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 36D2183060

Address:
640 N FOUNTAIN AVE
SPRINGFIELD, OH
ZIP 45504
Phone: (937) 323-1841
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MADISON AVENUE PHARMACY INC is a community/retail pharmacy pharmacy in Springfield, OH. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. MADISON AVENUE PHARMACY INC NPI is 1407930530. The provider is registered as an organization entity type.
The provider Is Doing Business As Madison Avenue Pharmacy Inc.

The provider's business location address is:

640 N FOUNTAIN AVE
SPRINGFIELD, OH
ZIP 45504-202
Phone: (937) 323-1841
Fax: (937) 323-1016

The provider's authorized official is Eric Juergens .
The authorized official title is Owner and has the following contact phone number (937) 323-1841.

The CLIA number assigned to this NPI record is 36D2183060 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/25/2006 and was last updated on 7/10/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacyNo
23336C0004XPharmacyCompounding PharmacyNo
33336C0003XPharmacyCommunity/Retail Pharmacy022269200OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12072490OTHERPK
26722650001MEDICARE NSC
30081137MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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