Organization
MEDICINE SHOPPE 1088 LLC
Active
Other names
Medicine Shoppe 1088
Organization subpart
No
Provider details
NPI number
Authorized official
TAMER IBRAHIM (PRESIDENT)
(330) 412-7442
Entity
Organization
Contact information
Practice address
345 N SANDUSKY AVE, BUCYRUS, OH 44820-1806
(419) 562-4222
(419) 562-4516
Mailing address
345 N SANDUSKY AVE, BUCYRUS, OH 44820-1806
(419) 562-4222
(419) 562-4516
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
02-735050
OH
3336C0003X
Community/Retail Pharmacy
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3654298
NCPDP #
OH
Enumeration date
08/25/2005
Last updated
03/13/2020
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