1750478400 NPI number — PHARMACY OPERATIONS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750478400 NPI number — PHARMACY OPERATIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY OPERATIONS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICINE SHOPPE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750478400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 RIDER TRAIL PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
EARTH CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63045-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-993-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-208-2893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
V.P., PHARMACY OPERATIONS
Authorized Official Telephone Number:
800-325-1397

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  02-0733300 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3658032 . This is a "NCPDP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 914078 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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