Healthcare Provider Details

I. General information

NPI: 1629138979
Provider Name (Legal Business Name): GROMOLL DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E OHIO AVE
SEBRING OH
44672-1410
US

IV. Provider business mailing address

227 N 15TH ST
SEBRING OH
44672
US

V. Phone/Fax

Practice location:
  • Phone: 330-938-6670
  • Fax: 330-938-6021
Mailing address:
  • Phone: 330-938-6670
  • Fax: 330-938-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02-0079650
License Number StateOH

VIII. Authorized Official

Name: MR. RAYMOND J POORBAUGH
Title or Position: OWNER
Credential: RPH
Phone: 330-938-6670