Healthcare Provider Details

I. General information

NPI: 1275621575
Provider Name (Legal Business Name): ANTWERP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST
ANTWERP OH
45813-0246
US

IV. Provider business mailing address

109 S. MAIN ST PO BOX 246
ANTWERP OH
45813-0246
US

V. Phone/Fax

Practice location:
  • Phone: 419-258-2068
  • Fax: 419-258-2444
Mailing address:
  • Phone: 419-258-2068
  • Fax: 419-258-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021130900
License Number StateOH

VIII. Authorized Official

Name: BELINDA RENNO
Title or Position: R.PH./OWNER
Credential: BS
Phone: 419-258-2068