Organization
REVENTION MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MISJA (OWNER)
(937) 681-9507
Entity
Organization
Contact information
Practice address
5900 N MAIN ST, DAYTON, OH 45415-3150
(937) 681-9507
Mailing address
5900 N MAIN ST, DAYTON, OH 45415-3150
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
RT851444
OH
Other
Enumeration date
01/31/2017
Last updated
01/31/2017
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