Healthcare Provider Details

I. General information

NPI: 1447397443
Provider Name (Legal Business Name): MECHANICSBURG DRUGGIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 S MAIN ST
MECHANICSBURG OH
43044-1111
US

IV. Provider business mailing address

PO BOX 126
PLAIN CITY OH
43064-0126
US

V. Phone/Fax

Practice location:
  • Phone: 937-834-2270
  • Fax: 937-834-3906
Mailing address:
  • Phone: 614-573-1557
  • Fax: 614-300-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020394900
License Number StateOH

VIII. Authorized Official

Name: LONNIE J CRAFT
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 614-573-1557