Healthcare Provider Details

I. General information

NPI: 1528078706
Provider Name (Legal Business Name): SCHWIETERMANS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W NORTH ST
COLDWATER OH
45828-1230
US

IV. Provider business mailing address

404 W NORTH ST
COLDWATER OH
45828-1230
US

V. Phone/Fax

Practice location:
  • Phone: 419-678-3435
  • Fax: 419-678-8511
Mailing address:
  • Phone: 419-678-3435
  • Fax: 419-678-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number020165150
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020165150
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number020165150
License Number StateOH

VIII. Authorized Official

Name: MR. DAVID J MCDONOUGH
Title or Position: OWNER
Credential: RPH
Phone: 419-678-3435