Healthcare Provider Details

I. General information

NPI: 1720061591
Provider Name (Legal Business Name): NEIDIG HEALTH CARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BOULEVARD ST
DOVER OH
44622-2006
US

IV. Provider business mailing address

PO BOX 1023
NEW PHILADELPHIA OH
44663-5123
US

V. Phone/Fax

Practice location:
  • Phone: 330-602-9473
  • Fax: 330-343-2442
Mailing address:
  • Phone: 330-602-9473
  • Fax: 330-343-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02-1523450
License Number StateOH

VIII. Authorized Official

Name: MR. JEFFREY A NEIDIG
Title or Position: MEMBER
Credential: RPH
Phone: 330-602-9473