| NPI | 1669577425 |
|---|---|
| Doing Business As | THE VINTAGE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ICKES Owner 440-963-7760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: OH 021800200) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-10-05 |