MEDICARE: HECKLER DRUG INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	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	3655961	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1659410603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HECKLER DRUG INC

Provider Business Mailing Address
First Line	:	812 COSHOCTON RD
Second Line	:	PO BOX 930
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-0930
Country	:	US
Telephone Number	:	740-393-3784
Fax Number	:	740-393-3783

Provider Business Practice Location Address
First Line	:	812 COSHOCTON AVE
Second Line	:	1
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1947
Country	:	US
Telephone Number	:	740-393-3784
Fax Number	:	740-393-3783

Authorized Official
Title or Position	:	PIC
Name	:	MARY LOU MONTENERY
Credential	:	RPH
Telephone Number	:	740-393-3784

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	11/14/2007

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Directions to “HECKLER DRUG INC ” Practice Location

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