Provider Demographics
NPI:1619356086
Name:ESSENTIAL MEDICAL SHOP, LLC
Entity Type:Organization
Organization Name:ESSENTIAL MEDICAL SHOP, LLC
Other - Org Name:ESSENTIAL MEDICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YAKUB
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-890-0449
Mailing Address - Street 1:8385 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1602
Mailing Address - Country:US
Mailing Address - Phone:937-890-0449
Mailing Address - Fax:937-890-0454
Practice Address - Street 1:8385 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1602
Practice Address - Country:US
Practice Address - Phone:937-890-0449
Practice Address - Fax:937-890-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL 11687332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHMEL 11687OtherSTATE LICENSE