Provider Demographics
NPI:1235585514
Name:SECUNDUM ARTEM ENTERPRISES INC
Entity Type:Organization
Organization Name:SECUNDUM ARTEM ENTERPRISES INC
Other - Org Name:THE MEDICINE SHOPPE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-653-3914
Mailing Address - Street 1:823 SCIOTO ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2223
Mailing Address - Country:US
Mailing Address - Phone:937-772-9640
Mailing Address - Fax:937-653-3914
Practice Address - Street 1:823 SCIOTO ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2223
Practice Address - Country:US
Practice Address - Phone:937-772-9640
Practice Address - Fax:937-653-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH022597450-033336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160002OtherPK
OH0252280001Medicare NSC