Provider Demographics
NPI:1891807806
Name:ARIES PHARMACY LLC
Entity Type:Organization
Organization Name:ARIES PHARMACY LLC
Other - Org Name:ARIES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SOLE MEMBER/RESPONSIBLE PHARM
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-633-7327
Mailing Address - Street 1:8200 STATE ROUTE 366
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RUSSELLS POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43348-9670
Mailing Address - Country:US
Mailing Address - Phone:973-843-3700
Mailing Address - Fax:937-843-2801
Practice Address - Street 1:8200 STATE ROUTE 366
Practice Address - Street 2:SUITE 3
Practice Address - City:RUSSELLS POINT
Practice Address - State:OH
Practice Address - Zip Code:43348-9670
Practice Address - Country:US
Practice Address - Phone:973-843-3700
Practice Address - Fax:937-843-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020495300333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0577666Medicaid
3643269OtherNCPDP
3643269OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3643269OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0577666Medicaid
OH0609810001Medicare NSC