# CHAMPION DISCOUNT PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Champion Discount Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275906554
- **Authorized official:** EDWARD TING (MEMBER, LLC)
- **Authorized official phone:** (330) 219-3005

## Contact information

- **Practice address:** 4299 MAHONING AVE NW, WARREN, OH 44483-1928
- **Practice address phone:** (330) 306-9616
- **Mailing address:** 4299 MAHONING AVE NW, WARREN, OH 44483-1928
- **Mailing address phone:** (234) 806-3137
- **Mailing address fax:** (234) 806-3138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/09/2015
- **Last updated:** 11/17/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0150213 | — | OH |
| 01 | — | 2154953 | PK | — |