Provider Demographics
NPI:1336413020
Name:SENIOR PHARMACY SERVICES LTD
Entity Type:Organization
Organization Name:SENIOR PHARMACY SERVICES LTD
Other - Org Name:SENIOR PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-857-9200
Mailing Address - Street 1:34099 MELINZ PARKWAY
Mailing Address - Street 2:UNIT J
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095
Mailing Address - Country:US
Mailing Address - Phone:440-942-8674
Mailing Address - Fax:440-942-8799
Practice Address - Street 1:34099 MELINZ PKWY UNIT J
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-4048
Practice Address - Country:US
Practice Address - Phone:440-942-8674
Practice Address - Fax:440-942-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0221793003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062029Medicaid
2133985OtherPK