1891716999 NPI number — COMMUNITY MARKET OF OHIO INC

Table of content: (NPI 1891716999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891716999 NPI number — COMMUNITY MARKET OF OHIO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MARKET OF OHIO 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:
COMMUNITY MARKETS 310 PHARMACY
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:
1891716999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 W MAIN CROSS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FINDLAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45840-3314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-422-8090
Provider Business Mailing Address Fax Number:
419-424-3932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43515-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-822-0306
Provider Business Practice Location Address Fax Number:
419-822-8452
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEST
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
567-208-6617

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  021265700 , 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: 2078347 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2248384 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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