Healthcare Provider Details

I. General information

NPI: 1134265960
Provider Name (Legal Business Name): BIRDIEKDOONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E MAIN ST
WEST JEFFERSON OH
43162-1247
US

IV. Provider business mailing address

245 E MAIN ST
WEST JEFFERSON OH
43162-1247
US

V. Phone/Fax

Practice location:
  • Phone: 614-879-9305
  • Fax: 614-879-9412
Mailing address:
  • Phone: 614-879-9305
  • Fax: 614-879-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT J. BORCHERS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 614-879-9305