Provider Demographics
NPI:1598203903
Name:COVENANT VENTURES INC.
Entity Type:Organization
Organization Name:COVENANT VENTURES INC.
Other - Org Name:CLASSIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIMDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-690-2594
Mailing Address - Street 1:1907 SE 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-5847
Mailing Address - Country:US
Mailing Address - Phone:352-694-2830
Mailing Address - Fax:
Practice Address - Street 1:1907 SE 58TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-5847
Practice Address - Country:US
Practice Address - Phone:352-694-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy