Organization
PRIME PHARMACY INC
Active
Other names
MEDI MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND FANKELL RPH (OWNER/PHARMACIST)
(740) 354-3291
Entity
Organization
Contact information
Practice address
902 4TH ST, PORTSMOUTH, OH 45662-4314
(740) 354-3291
(740) 354-3292
Mailing address
902 4TH ST, PORTSMOUTH, OH 45662-4314
(740) 354-3291
(740) 354-3292
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RTP.020589200-02
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0738410
—
OH
01
—
2071105
PK
—
Enumeration date
08/10/2006
Last updated
08/01/2014
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