Prime Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RTP.020589200-02 Issued in OH

Legal business name

PRIME PHARMACY INC

Doing business as

Medi Mart Pharmacy

Practice address

902 4TH St
Portsmouth, OH 45662-4314

Phone

(740) 354-3291

Fax

(740) 354-3292

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Raymond Fankell, RPH

Title

Owner/Pharmacist

Phone

(740) 354-3291

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDI MART PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1205847860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 4TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456624314",
            "telephone_number": "740-354-3291",
            "fax_number": "740-354-3292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 4TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456624314",
            "telephone_number": "740-354-3291",
            "fax_number": "740-354-3292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "FANKELL",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "740-354-3291",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "RTP.020589200-02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0738410",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2071105",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDI MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mary Pritchard, RPH
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• Alexander Craig Provaznik
• Jaime M Pua, MD

• Community/Retail Pharmacy in Portsmouth, OH
• Providers in Portsmouth, OH by specialty
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.