MEDICARE: DISCOUNT DRUG MART INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	021341050	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2078609	OTHER		PK

General Provider Information

NPI Number	:	1023053030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOUNT DRUG MART INC

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

Provider Business Practice Location Address
First Line	:	25 BRIGGS DR
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-3805
Country	:	US
Telephone Number	:	419-529-8101
Fax Number	:	419-529-9301

Authorized Official
Title or Position	:	PHARMACY COORDINATOR
Name	:	LAURA TAYLOR
Credential	:	CPHT
Telephone Number	:	330-725-2340

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	03/06/2017

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