# MADISON AVENUE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487434205
- **Authorized official:** ERIC TIMOTHY JUERGENS (PRESIDENT)
- **Authorized official phone:** (937) 323-1841

## Contact information

- **Practice address:** 640 N FOUNTAIN AVE, SPRINGFIELD, OH 45504-2202
- **Practice address phone:** (937) 323-1841
- **Practice address fax:** (937) 323-1016
- **Mailing address:** 640 N FOUNTAIN AVE, SPRINGFIELD, OH 45504-2202
- **Mailing address phone:** (937) 323-1841
- **Mailing address fax:** (937) 323-1016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/29/2023
- **Last updated:** 09/29/2023