Organization
MINERVA PHARMACY INC
Active
Other names
The Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA EVANICH R PH (PHARMACIST)
(330) 453-4804
Entity
Organization
Contact information
Practice address
251 EAST ST, MINERVA, OH 44657-1617
(330) 868-6200
(330) 453-7688
Mailing address
2601 TUSCARAWAS ST W, CANTON, OH 44708-4603
(330) 453-4804
(330) 453-7688
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
03-2-19719
OH
3336C0003X
Community/Retail Pharmacy
Primary
03-2-19719
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0853901
—
OH
01
—
3656292
NAPB
OH
Enumeration date
09/28/2006
Last updated
12/17/2007
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