Champion Discount Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

CHAMPION DISCOUNT PHARMACY, LLC

Practice address

4299 Mahoning Ave NW
Warren, OH 44483-1928

Phone

(330) 306-9616

NPI assigned

Nov 9, 2015

Organization subpart

No

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

Authorized official

Name

Edward TingNPI 1891808408

Title

Member, LLC

Phone

(330) 219-3005

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Champion Discount Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 2

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

• Edward Ting, R.PH.

  • Pharmacist
  • Kinsman, OH
  • NPI 1891808408
  NPD Authorized official
• Lindsay Ann Coulter, PHARMD

  • Pharmacist
  • Warren, OH
  • NPI 1417419177
  NPD (past)

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1275906554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4299 MAHONING AVE NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444831928",
            "telephone_number": "234-806-3137",
            "fax_number": "234-806-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4299 MAHONING AVE NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444831928",
            "telephone_number": "330-306-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION DISCOUNT PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-09",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "TING",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "MEMBER, LLC",
        "authorized_official_telephone_number": "330-219-3005"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150213",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2154953",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champion Discount Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diane Chachko, PHARM.D.
• Michael Chachko
• Charone Chalou
• Shari Ann Chambers
• Champion Dialysis Center LLC
• Champion Local School District
• Champion Med Express Care LLC
• Champion Township Trustees
• Emily Ann Chaney
• Jane Choo Chang-Vitkoczy, LPN

• Community/Retail Pharmacy in Warren, OH
• Providers in Warren, 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 Nov 17, 2016; 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.