Provider Demographics
NPI:1427565092
Name:CORE PHARMACY LLC
Entity Type:Organization
Organization Name:CORE PHARMACY LLC
Other - Org Name:CORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:216-359-1600
Mailing Address - Street 1:681 BROOKLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-3086
Mailing Address - Country:US
Mailing Address - Phone:216-536-3923
Mailing Address - Fax:
Practice Address - Street 1:6180 HALLE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-4635
Practice Address - Country:US
Practice Address - Phone:216-359-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy