Healthcare Provider Details

I. General information

NPI: 1114052982
Provider Name (Legal Business Name): EDWARD PETER CASSIDY JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N HIGH ST
COLUMBUS GROVE OH
45830
US

IV. Provider business mailing address

PO BOX 126
COLUMBUS GROVE OH
45830
US

V. Phone/Fax

Practice location:
  • Phone: 419-659-2366
  • Fax: 419-659-2346
Mailing address:
  • Phone: 419-659-2366
  • Fax: 419-659-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03126052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: