# MEDICINE SHOPPE 1088 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicine Shoppe 1088
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083607923
- **Authorized official:** TAMER IBRAHIM (PRESIDENT)
- **Authorized official phone:** (330) 412-7442

## Contact information

- **Practice address:** 345 N SANDUSKY AVE, BUCYRUS, OH 44820-1806
- **Practice address phone:** (419) 562-4222
- **Practice address fax:** (419) 562-4516
- **Mailing address:** 345 N SANDUSKY AVE, BUCYRUS, OH 44820-1806
- **Mailing address phone:** (419) 562-4222
- **Mailing address fax:** (419) 562-4516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 02-735050 | OH | — |
| 3336C0003X | Community/Retail Pharmacy | — | OH | Yes |

## Other

- **Enumeration date:** 08/25/2005
- **Last updated:** 03/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3654298 | NCPDP \# | OH |