Provider Demographics
NPI:1962233395
Name:MAYBERRY PHARMACY LLC
Entity type:Organization
Organization Name:MAYBERRY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-517-1120
Mailing Address - Street 1:8257 MAYBERRY SQ S
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9458
Mailing Address - Country:US
Mailing Address - Phone:419-517-1120
Mailing Address - Fax:419-517-1349
Practice Address - Street 1:8257 MAYBERRY SQ S
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9458
Practice Address - Country:US
Practice Address - Phone:419-517-1120
Practice Address - Fax:419-517-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy