| NPI | 1407930530 |
|---|---|
| Doing Business As | MADISON AVENUE PHARMACY INC |
| Entity Type | Organization |
| Authorized Contact | ERIC JUERGENS Owner 937-323-1841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: OH 022269200) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2013-07-10 |