Provider Demographics
NPI:1093227274
Name:AKRON PHARMACY
Entity Type:Organization
Organization Name:AKRON PHARMACY
Other - Org Name:MAC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKARYOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-375-5040
Mailing Address - Street 1:879 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1127
Mailing Address - Country:US
Mailing Address - Phone:330-375-5040
Mailing Address - Fax:330-375-5048
Practice Address - Street 1:1 PARK WEST BLVD STE 140
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4230
Practice Address - Country:US
Practice Address - Phone:330-556-4515
Practice Address - Fax:330-556-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-28
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336M0002X, 3336S0011X
OHPMY022852850033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259448Medicaid
2175166OtherPK