Provider Demographics
NPI:1083432363
Name:SYLVANIA RX LLC
Entity type:Organization
Organization Name:SYLVANIA RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAROUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:419-320-5119
Mailing Address - Street 1:6600 SYLVANIA AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3933
Mailing Address - Country:US
Mailing Address - Phone:419-517-1085
Mailing Address - Fax:419-517-2044
Practice Address - Street 1:6600 SYLVANIA AVE STE 1E
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3933
Practice Address - Country:US
Practice Address - Phone:419-517-1085
Practice Address - Fax:419-517-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy