Provider Demographics
NPI:1558492652
Name:LEXINGTON PHARMACY INC
Entity Type:Organization
Organization Name:LEXINGTON PHARMACY INC
Other - Org Name:LEXINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-884-2727
Mailing Address - Street 1:298 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:298 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1300
Practice Address - Country:US
Practice Address - Phone:419-884-2727
Practice Address - Fax:419-884-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3616008OtherOTHER ID NUMBER
OH0803161Medicaid
3616008OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0458490001Medicare NSC