Provider Demographics
NPI:1912073859
Name:OLDE TOWN MEDICINE & SUNDRIES, LLC
Entity Type:Organization
Organization Name:OLDE TOWN MEDICINE & SUNDRIES, LLC
Other - Org Name:CONTINUUM CARE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:HAMBLY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-422-7705
Mailing Address - Street 1:1100 CENTRAL AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4011
Mailing Address - Country:US
Mailing Address - Phone:513-422-7705
Mailing Address - Fax:513-422-9238
Practice Address - Street 1:1100 CENTRAL AVE FL 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4011
Practice Address - Country:US
Practice Address - Phone:513-422-7705
Practice Address - Fax:513-422-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1477400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546178Medicaid
KY5401007900Medicaid
IN200507700AMedicaid
OH5419060001Medicare ID - Type Unspecified