Madison Avenue Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

022269200 Issued in OH

Legal business name

MADISON AVENUE PHARMACY INC

Doing business as

MADISON AVENUE PHARMACY INC

Practice address

640 N Fountain Ave
Springfield, OH 45504-2202

Phone

(937) 323-1841

Fax

(937) 323-1016

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Eric Juergens, RPH

Title

Owner

Phone

(937) 323-1841

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• MADISON AVENUE PHARMACY INC Doing business as

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1407930530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 N FOUNTAIN AVE",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042202",
            "telephone_number": "937-323-1841",
            "fax_number": "937-323-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 N FOUNTAIN AVE",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042202",
            "telephone_number": "937-323-1841",
            "fax_number": "937-323-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON AVENUE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "JUERGENS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-323-1841",
        "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": "022269200",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2072490",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0081137",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON AVENUE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mad River Township
• Kathalene Maddy
• Farzaneh Mader
• Joseph Patrick Mader, AA
• Madison Avenue Pharmacy
• Madison Avenue Pharmacy Inc
• Jeffrey William Maendel
• Jayde Magee
• Mitchell J Maginnis, OD
• Mark Thomas Main, PT

• Community/Retail Pharmacy in Springfield, OH
• Providers in Springfield, 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 Jul 10, 2013; 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.