1265477277 NPI number — DISCOUNT DRUG MART INC

Table of content: (NPI 1265477277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265477277 NPI number — DISCOUNT DRUG MART INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISCOUNT DRUG MART INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DISCOUNT DRUG MART
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265477277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 COMMERCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-725-2340
Provider Business Mailing Address Fax Number:
330-764-4857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 HILL RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-8884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-920-3330
Provider Business Practice Location Address Fax Number:
614-920-9772
Provider Enumeration Date:
06/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY COORDINATOR
Authorized Official Telephone Number:
330-725-2340

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 021336050 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2078610 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2363937 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".