Healthcare Provider Details

I. General information

NPI: 1639676141
Provider Name (Legal Business Name): DISCOUNT DRUG MART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33381 WALKER RD STE C
AVON LAKE OH
44012-1463
US

IV. Provider business mailing address

211 COMMERCE DR
MEDINA OH
44256-1331
US

V. Phone/Fax

Practice location:
  • Phone: 216-750-4037
  • Fax: 440-848-8574
Mailing address:
  • Phone: 330-725-2340
  • Fax: 330-764-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number022880100
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURA TAYLOR
Title or Position: PHARMACY COORDINATOR
Credential:
Phone: 330-725-2340