Healthcare Provider Details

I. General information

NPI: 1730518796
Provider Name (Legal Business Name): MAIN STREET PHARMACY & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2013
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N MAIN ST
ORRVILLE OH
44667-1638
US

IV. Provider business mailing address

120 N MAIN ST
ORRVILLE OH
44667-1638
US

V. Phone/Fax

Practice location:
  • Phone: 330-682-2905
  • Fax: 330-682-2907
Mailing address:
  • Phone: 330-682-2905
  • Fax: 330-682-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVEN SEIFRIED
Title or Position: PRESIDENT
Credential:
Phone: 330-466-5063