Provider Demographics
NPI:1821133869
Name:YELLOW SPRINGS PHARMACY LLC
Entity Type:Organization
Organization Name:YELLOW SPRINGS PHARMACY LLC
Other - Org Name:YELLOW SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-304-2221
Mailing Address - Street 1:263 XENIA AVE
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387
Mailing Address - Country:US
Mailing Address - Phone:937-767-1070
Mailing Address - Fax:937-767-9209
Practice Address - Street 1:263 XENIA AVE
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1832
Practice Address - Country:US
Practice Address - Phone:937-767-1070
Practice Address - Fax:937-767-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074469OtherPK
OH2776616Medicaid
2074469OtherPK