Healthcare Provider Details

I. General information

NPI: 1720012958
Provider Name (Legal Business Name): C & B MAIN DISCOUNT DRUG CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 MAIN ST
KINSMAN OH
44428-9333
US

IV. Provider business mailing address

8507 MAIN ST
KINSMAN OH
44428-9333
US

V. Phone/Fax

Practice location:
  • Phone: 330-876-1228
  • Fax: 330-876-1229
Mailing address:
  • Phone: 330-876-1228
  • Fax: 330-876-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02369400
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number02369400
License Number StateOH

VIII. Authorized Official

Name: MR. EDWARD L TING
Title or Position: PRESIDENT
Credential: RPH
Phone: 330-876-1228