Provider Demographics
NPI:1609889575
Name:MEDICINE SHOPPE 2000 LLC
Entity Type:Organization
Organization Name:MEDICINE SHOPPE 2000 LLC
Other - Org Name:MEDICINE SHOPPE 2000
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-412-7442
Mailing Address - Street 1:114 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-1210
Mailing Address - Country:US
Mailing Address - Phone:740-862-4240
Mailing Address - Fax:740-862-3155
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-1210
Practice Address - Country:US
Practice Address - Phone:740-862-4240
Practice Address - Fax:740-862-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 333600000X
OH0203442003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340231Medicaid
2142882OtherPK
0240990001Medicare NSC