Organization
MADISON AVENUE PHARMACY INC
Active
Other names
MADISON AVENUE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JUERGENS RPH (OWNER)
(937) 323-1841
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
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
022269200
OH
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081137
—
OH
01
—
2072490
PK
—
Enumeration date
10/25/2006
Last updated
07/10/2013
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