Healthcare Provider Details

I. General information

NPI: 1952473407
Provider Name (Legal Business Name): NEW MIDDLETOWN VILLAGE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10395 MAIN ST
NEW MIDDLETOWN OH
44442-0289
US

IV. Provider business mailing address

PO BOX 289
NEW MIDDLETOWN OH
44442-0289
US

V. Phone/Fax

Practice location:
  • Phone: 330-542-2802
  • Fax: 330-542-2035
Mailing address:
  • Phone: 330-542-2802
  • Fax: 330-542-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020115550
License Number StateOH

VIII. Authorized Official

Name: MARK WILLIAM JOHNSON
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 330-542-2802