Provider Demographics
NPI:1326320557
Name:ADENA PHARMACY, LLC
Entity Type:Organization
Organization Name:ADENA PHARMACY, LLC
Other - Org Name:ADENA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASS. PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-779-8763
Mailing Address - Street 1:4439 STATE ROUTE 159
Mailing Address - Street 2:SUITE G40
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8207
Mailing Address - Country:US
Mailing Address - Phone:740-779-8763
Mailing Address - Fax:740-779-8769
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:SUITE G40
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-8763
Practice Address - Fax:740-779-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0221358503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3679911OtherNCPDP PROVIDER IDENTIFICATION NUMBER