Healthcare Provider Details

I. General information

NPI: 1144390220
Provider Name (Legal Business Name): WILLARD FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 SANDUSKY ST
PLYMOUTH OH
44865-1151
US

IV. Provider business mailing address

262 SANDUSKY ST
PLYMOUTH OH
44865-1151
US

V. Phone/Fax

Practice location:
  • Phone: 419-687-5332
  • Fax: 419-687-7685
Mailing address:
  • Phone: 419-687-5332
  • Fax: 419-687-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021950600
License Number StateOH

VIII. Authorized Official

Name: MICHELLE KRIETEMEYER
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 419-687-5332