1891807806 NPI number — ARIES PHARMACY LLC

Table of content: (NPI 1891807806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891807806 NPI number — ARIES PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIES PHARMACY LLC
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:
ARIES PHARMACY
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:
1891807806
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:
8200 STATE ROUTE 366
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
RUSSELLS POINT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43348-9670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-843-3700
Provider Business Mailing Address Fax Number:
937-843-2801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 STATE ROUTE 366
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
RUSSELLS POINT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43348-9670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-843-3700
Provider Business Practice Location Address Fax Number:
937-843-2801
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SOLE MEMBER/RESPONSIBLE PHARM
Authorized Official Telephone Number:
614-633-7327

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  020495300 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0577666 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3643269 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3643269 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".