Provider Demographics
NPI:1043638174
Name:PHARMA MEDICAL LLC
Entity Type:Organization
Organization Name:PHARMA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-616-9590
Mailing Address - Street 1:687 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-6519
Mailing Address - Country:US
Mailing Address - Phone:513-616-9590
Mailing Address - Fax:
Practice Address - Street 1:687 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-6519
Practice Address - Country:US
Practice Address - Phone:513-616-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0223557003336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy