Healthcare Provider Details

I. General information

NPI: 1932190923
Provider Name (Legal Business Name): DANVILLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E. MAIN ST.
DANVILLE OH
43014-0070
US

IV. Provider business mailing address

10 E. MAIN ST.
DANVILLE OH
43014-0070
US

V. Phone/Fax

Practice location:
  • Phone: 740-599-6744
  • Fax: 740-599-6799
Mailing address:
  • Phone: 740-599-6744
  • Fax: 740-599-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number020636650
License Number StateOH

VIII. Authorized Official

Name: MR. ERIC D SIEKKINEN
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 740-599-6744