Provider Demographics
NPI:1073942835
Name:PHARMACY COUNTER, LLC
Entity Type:Organization
Organization Name:PHARMACY COUNTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-473-1493
Mailing Address - Street 1:2655 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3550
Mailing Address - Country:US
Mailing Address - Phone:419-473-1493
Mailing Address - Fax:419-474-7137
Practice Address - Street 1:1661 HOLLAND RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4207
Practice Address - Country:US
Practice Address - Phone:419-720-2005
Practice Address - Fax:419-720-2006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMEDICA PHYSICIANS GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115526Medicaid
6366510011Medicare NSC