Healthcare Provider Details

I. General information

NPI: 1992734735
Provider Name (Legal Business Name): B & W PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DIETZ LANE
BEVERLY OH
45715
US

IV. Provider business mailing address

PO BOX 697
BEVERLY OH
45715
US

V. Phone/Fax

Practice location:
  • Phone: 740-984-2305
  • Fax: 740-984-2522
Mailing address:
  • Phone: 740-984-2305
  • Fax: 740-984-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number02-0084350
License Number StateOH

VIII. Authorized Official

Name: MR. CHADWICK RYAN HUCK
Title or Position: JUNIOR PARTNER/PHARMACIST
Credential: R.PH.
Phone: 740-984-2305