Provider Demographics
NPI:1760163463
Name:TOTAL CARE PHARMACY LLC
Entity Type:Organization
Organization Name:TOTAL CARE PHARMACY LLC
Other - Org Name:TOTAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DWOMOH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-223-9262
Mailing Address - Street 1:5174 PLEASANT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2648
Mailing Address - Country:US
Mailing Address - Phone:513-805-4114
Mailing Address - Fax:513-805-4071
Practice Address - Street 1:5174 PLEASANT AVE STE C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2648
Practice Address - Country:US
Practice Address - Phone:513-805-4114
Practice Address - Fax:513-805-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0026666Medicaid