Provider Demographics
NPI:1801589734
Name:HICARE PHARMACY LLC
Entity type:Organization
Organization Name:HICARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4140 SALEM AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1703
Mailing Address - Country:US
Mailing Address - Phone:937-723-6034
Mailing Address - Fax:937-723-6415
Practice Address - Street 1:8769 N MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1392
Practice Address - Country:US
Practice Address - Phone:937-723-6034
Practice Address - Fax:937-723-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0018895Medicaid