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Organization
MADISON AVENUE PHARMACY INC
Active
Organization
MADISON AVENUE PHARMACY INC
Active
Other names
MADISON AVENUE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JUERGENS RPH (OWNER)
(937) 323-1841
Entity
Organization
Contact information
Practice address
640 N FOUNTAIN AVE, SPRINGFIELD, OH 45504-2202
(937) 323-1841
(937) 323-1016
Mailing address
640 N FOUNTAIN AVE, SPRINGFIELD, OH 45504-2202
(937) 323-1841
(937) 323-1016
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
022269200
OH
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081137
—
OH
01
—
2072490
PK
—
Enumeration date
10/25/2006
Last updated
07/10/2013
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