Healthcare Provider Details

I. General information

NPI: 1457399131
Provider Name (Legal Business Name): DBA EAST MAIN STREET PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 E MAIN ST
COLUMBUS OH
43205-2081
US

IV. Provider business mailing address

1336 E MAIN ST
COLUMBUS OH
43205-2081
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-1998
  • Fax: 614-252-3910
Mailing address:
  • Phone: 614-252-1998
  • Fax: 614-252-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021074900
License Number StateOH

VIII. Authorized Official

Name: MR. HAROLD EUGENE FLETCHER
Title or Position: OWNER AND CHIEF PHARMACIST
Credential: RPH
Phone: 614-252-1998