Provider Demographics
NPI:1598879579
Name:WAPAK PHARMACY INC
Entity Type:Organization
Organization Name:WAPAK PHARMACY INC
Other - Org Name:CENTER HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCONCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPL
Authorized Official - Phone:937-596-6621
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E PIKE ST
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:OH
Practice Address - Zip Code:45334
Practice Address - Country:US
Practice Address - Phone:937-596-6621
Practice Address - Fax:937-596-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OH333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0713491Medicaid
3650226OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0989640001Medicare ID - Type Unspecified