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Organization
CHAMPION DISCOUNT PHARMACY, LLC
Active
Organization
CHAMPION DISCOUNT PHARMACY, LLC
Active
Other names
Champion Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD TING (MEMBER, LLC)
(330) 219-3005
Entity
Organization
Contact information
Practice address
4299 MAHONING AVE NW, WARREN, OH 44483-1928
(330) 306-9616
Mailing address
4299 MAHONING AVE NW, WARREN, OH 44483-1928
(234) 806-3137
(234) 806-3138
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150213
—
OH
01
—
2154953
PK
—
Enumeration date
11/09/2015
Last updated
11/17/2016
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