Healthcare Provider Details

I. General information

NPI: 1982987160
Provider Name (Legal Business Name): GREGORY MICHAEL HALDIMAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 E STATE ST
SALEM OH
44460-2455
US

IV. Provider business mailing address

2124 E STATE ST
SALEM OH
44460-2455
US

V. Phone/Fax

Practice location:
  • Phone: 330-337-8001
  • Fax: 330-337-8031
Mailing address:
  • Phone: 330-337-8001
  • Fax: 330-337-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03127672-1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0034142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: