Healthcare Provider Details

I. General information

NPI: 1316051394
Provider Name (Legal Business Name): SOUTH WEBSTER PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11016 MAIN ST
SOUTH WEBSTER OH
45682-7501
US

IV. Provider business mailing address

741 2ND ST
PORTSMOUTH OH
45662-4001
US

V. Phone/Fax

Practice location:
  • Phone: 740-778-3784
  • Fax: 740-778-3782
Mailing address:
  • Phone: 740-354-5622
  • Fax: 740-353-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021558550
License Number StateOH

VIII. Authorized Official

Name: MICHAEL STURGILL
Title or Position: OWNER
Credential: RPH
Phone: 740-354-5622