PEMBERVILLE DRUG STORE LLC (NPI# 1881766418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881766418 |
| Entity Type | Organization |
| Organization Name | PEMBERVILLE DRUG STORE LLC |
| Other Organization Name | PEMBERVILLE DRUG STORE |
| Practice Address |
143 E Front St Pemberville OH 43450-7032 |
| Mailing Address |
Po Box 897 Pemberville OH 43450-0897 |
| Practice Telephone | 4192873238 |
| Practice Fax Number | 4192872008 |
| Mailing Telephone | 4192873238 |
| Mailing Fax Number | 4192872008 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2017-01-18 |
| Authorized Official Name | JOSEPH BAUMGARTNER (PRESIDENT) |
| Authorized Official Telephone | 4192873238 |
| Authorized Official Credential | PHARMACIST |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
RTP.022122100-3 | OH | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2130702 | 01 | |
| OH | 2010620 | 05 |
| Other Name | Type Code |
|---|---|
| Pemberville Drug Store | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184907115 | Pemberville Drug Store LLC | Pharmacy | 139 E Front St # 897, Pemberville, OH 43450-7032 | 2011-09-26 |
| Street Address |
143 E FRONT ST |
| City | PEMBERVILLE |
| State | OH |
| Zip Code | 43450-7032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780656082 | Rebecca L. Krukemyer | Audiologist | 133 East Front St., Pemberville, OH 43450 | 2006-02-02 |
| 1437146867 | William O Donnelly | Psychologist | 429 W. College Ave, Donnelly Community Psychology, Pemberville, OH 43450 | 2005-09-30 |
| 1053452490 | Jon Timothy Truman | Chiropractor | 131 E Front St, Pemberville, OH 43450-0415 | 2007-02-09 |
| 1295829703 | Pre Cursor Inc | Durable Medical Equipment & Medical Supplies | 143 East Front Street, Pemberville, OH 43450-0897 | 2006-10-02 |
| 1396243069 | Ags Holding LLC | Pharmacy | 209 Bierley Ave, Pemberville, OH 43450-7003 | 2018-01-29 |
| 1184907115 | Pemberville Drug Store LLC | Pharmacy | 139 E Front St # 897, Pemberville, OH 43450-7032 | 2011-09-26 |
| 1881868784 | Portage Valley Hearing, LLC | Clinic/Center | 133 E Front St, Pemberville, OH 43450-7032 | 2008-04-22 |
| 1750467783 | John T Archer & Associates Inc | Optometrist | 213 E Front St, Pemberville, OH 43450-7036 | 2006-10-31 |
| 1285860528 | Portage River Rehab | Occupational Therapist | 222 E Front St, Ste 3, Pemberville, OH 43450-7105 | 2009-06-01 |
| 1467787333 | Amy Andrews | Speech-Language Pathologist | 222 E Front St, Ste 135 B, Pemberville, OH 43450-7105 | 2009-10-12 |
| Find all providers in zip 43450 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1144868597 | Blanchard Valley Regional Health Center | Pharmacy | 930 Sheriden Dr Ste C, Carey, OH 43316-1502 | 2019-12-17 |
| Find all providers with the same taxonomy | ||||
| City | PEMBERVILLE |
| Zip Code | 43450 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.