Organization
MADISON AVENUE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINGER LYNNETTE HENNIG L.PED. (PEDORTHIST)
(937) 788-2402
Entity
Organization
Contact information
Practice address
640 N FOUNTAIN AVE, SPRINGFIELD, OH 45504-2202
(937) 323-1841
(937) 323-1016
Mailing address
640 N FOUNTAIN AVE, SPRINGFIELD, OH 45504-2202
(937) 323-1841
(937) 323-1016
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
LPED110
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0970883
—
OH
Enumeration date
02/20/2007
Last updated
08/13/2008
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