1326543992 NPI number — DISCOUNT DRUG MART INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326543992 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:
Provider Other Organization Name Type Code:
6
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:
1326543992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
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:
8023 CRILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44077-9180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-853-2542
Provider Business Practice Location Address Fax Number:
440-358-1583
Provider Enumeration Date:
03/27/2018

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: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 022875000 , 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: 2176744 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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