NPIMap

Organization Active NPI

Medicine Shoppe 1088 LLC

  • Community/Retail Pharmacy
  • Bucyrus, OH
National Provider Identifier
1083607923
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEDICINE SHOPPE 1088 LLC
Doing business as
Medicine Shoppe 1088
Practice address
345 N Sandusky Ave
Bucyrus, OH 44820-1806
Phone
(419) 562-4222
Fax
(419) 562-4516
NPI assigned
Aug 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tamer IbrahimNPI 1457641896
Title
President
Phone
(330) 412-7442

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 02-735050 OH
Community/Retail Pharmacy 3336C0003X OH Primary

Addresses

Primary practice location

345 N Sandusky Ave
Bucyrus, OH 44820-1806

Mailing address

345 N Sandusky Ave
Bucyrus, OH 44820-1806
Phone (419) 562-4222

Other identifiers 1

IdentifierTypeStateIssuer
3654298OtherOHNCPDP #

Other names 1

  • Medicine Shoppe 1088 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200518002689 OH Part B Supplier - Pharmacy 2264863679 Practice locations: Bucyrus, OH
O20200602001185 OH DME Supplier - Pharmacy 2264863679 Practice locations: Bucyrus, OH

National Provider Directory

National Provider Directory
Tax ID family
Medicine Shoppe 10882 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1083607923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 N SANDUSKY AVE",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448201806",
            "telephone_number": "419-562-4222",
            "fax_number": "419-562-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 N SANDUSKY AVE",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448201806",
            "telephone_number": "419-562-4222",
            "fax_number": "419-562-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE SHOPPE 1088 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "TAMER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-412-7442"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OH",
            "license": "02-735050",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "3654298",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Shoppe 1088",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bucyrus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.