Provider Demographics
NPI:1205385333
Name:UPTOWN PHARMACY LLC
Entity Type:Organization
Organization Name:UPTOWN PHARMACY LLC
Other - Org Name:ESSENTRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:419-253-0732
Mailing Address - Street 1:73 SPORTSMAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-1800
Mailing Address - Country:US
Mailing Address - Phone:419-253-0632
Mailing Address - Fax:419-253-0622
Practice Address - Street 1:73 SPORTSMAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-1800
Practice Address - Country:US
Practice Address - Phone:419-253-0632
Practice Address - Fax:419-253-0622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPTOWN PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-30
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022629350332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy