# HYS HEALTH MART INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICINE CENTER PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134497175
- **Authorized official:** SAM SALOUHA RPH (PRESIDENT)
- **Authorized official phone:** (440) 366-1035

## Contact information

- **Practice address:** 403 CLEVELAND ST, ELYRIA, OH 44035-6143
- **Practice address phone:** (440) 366-1035
- **Practice address fax:** (440) 366-0028
- **Mailing address:** 403 CLEVELAND ST, ELYRIA, OH 44035-6143
- **Mailing address phone:** (440) 366-1035
- **Mailing address fax:** (440) 366-0028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RTP.022177550 | OH | Yes |

## Other

- **Enumeration date:** 12/05/2011
- **Last updated:** 12/06/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0063260 | — | OH |
| 01 | — | 2132941 | PK | — |