Provider Demographics
NPI:1689758849
Name:C & R PHARMACY, LLC
Entity Type:Organization
Organization Name:C & R PHARMACY, LLC
Other - Org Name:C & R PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-650-3333
Mailing Address - Street 1:204 N DETROIT ST
Mailing Address - Street 2:PO BOX 761
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357
Mailing Address - Country:US
Mailing Address - Phone:937-650-3333
Mailing Address - Fax:937-650-3335
Practice Address - Street 1:204 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357
Practice Address - Country:US
Practice Address - Phone:937-650-3333
Practice Address - Fax:937-650-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1345250333600000X
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3671181OtherNCPDP #
OH2374318Medicaid
OHBM8152528OtherDEA #
OH3671181OtherNCPDP #