Healthcare Provider Details

I. General information

NPI: 1669537080
Provider Name (Legal Business Name): ANDERSONS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MAIN ST
CHILLICOTHEE OH
45601-2506
US

IV. Provider business mailing address

160 E MAIN ST
CHILLICOTHEE OH
45601-2506
US

V. Phone/Fax

Practice location:
  • Phone: 740-774-2670
  • Fax: 740-779-0296
Mailing address:
  • Phone: 740-774-2670
  • Fax: 740-779-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number02106200
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID M DIXON
Title or Position: VP AND MGR
Credential:
Phone: 740-774-2670