Organization
CHAMPION DISCOUNT PHARMACY, LLC
Active
Other names
Champion Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD TING (MEMBER, LLC)
(330) 219-3005
Entity
Organization
Contact information
Practice address
4299 MAHONING AVE NW, WARREN, OH 44483-1928
(330) 306-9616
Mailing address
4299 MAHONING AVE NW, WARREN, OH 44483-1928
(234) 806-3137
(234) 806-3138
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150213
—
OH
01
—
2154953
PK
—
Enumeration date
11/09/2015
Last updated
11/17/2016
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