Provider Demographics
NPI:1225581150
Name:TOLEDO FAMILY PHARMACY MAIN ST LLC
Entity Type:Organization
Organization Name:TOLEDO FAMILY PHARMACY MAIN ST LLC
Other - Org Name:TOLEDO FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACIST,AO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-414-0249
Mailing Address - Street 1:1601 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1532
Mailing Address - Country:US
Mailing Address - Phone:419-470-0700
Mailing Address - Fax:419-470-0702
Practice Address - Street 1:324 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2038
Practice Address - Country:US
Practice Address - Phone:419-930-5830
Practice Address - Fax:419-464-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRTP.022629850-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162367OtherPK
OH0179072Medicaid
OH1225581150Medicaid