Organization
EMMANUEL VENTURES LIMITED LLC
Active
Other names
Severance Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OPEYEMI ADEWESO RPH (PHARMACIST IN CHARGE)
(216) 691-2369
Entity
Organization
Contact information
Practice address
4127 E 131ST ST, MILES SUPERMARKET, CLEVELAND, OH 44105-5563
(216) 691-2369
(216) 691-3119
Mailing address
4127 E 131ST ST, MILES SUPERMARKET, CLEVELAND, OH 44105-5563
(216) 691-2369
(216) 691-3119
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RTP.022607100-03
OH
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136201
PK
—
Enumeration date
07/25/2012
Last updated
03/30/2017
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