1841387040 NPI number — THE DRUGSTORE AT O'BLENESS LLC

Table of content: (NPI 1841387040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841387040 NPI number — THE DRUGSTORE AT O'BLENESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DRUGSTORE AT O'BLENESS LLC
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:
1841387040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/24/2020
NPI Reactivation Date:
12/02/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
934 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-566-4690
Provider Business Mailing Address Fax Number:
740-566-4691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
934 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-566-4690
Provider Business Practice Location Address Fax Number:
740-566-4691
Provider Enumeration Date:
10/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZATTA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
740-359-4513

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 021621000 , 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: 2080485 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com