Provider Demographics
NPI:1952351637
Name:IHS PHARMACY AND WELLNESS CTR LLC
Entity Type:Organization
Organization Name:IHS PHARMACY AND WELLNESS CTR LLC
Other - Org Name:IHS PHARMACY AND WELLNESS CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-257-5309
Mailing Address - Street 1:77 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4716
Mailing Address - Country:US
Mailing Address - Phone:937-482-0328
Mailing Address - Fax:937-482-0342
Practice Address - Street 1:77 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4716
Practice Address - Country:US
Practice Address - Phone:937-482-0328
Practice Address - Fax:937-482-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0215840003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3674505OtherNCPDP PROVIDER IDENTIFICATION NUMBER