Healthcare Provider Details

I. General information

NPI: 1427489467
Provider Name (Legal Business Name): WEST JEFFERSON DRUGGIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 W MAIN ST
WEST JEFFERSON OH
43162-1178
US

IV. Provider business mailing address

PO BOX 126
PLAIN CITY OH
43064-0126
US

V. Phone/Fax

Practice location:
  • Phone: 614-879-8500
  • Fax: 614-879-6171
Mailing address:
  • Phone: 614-573-1557
  • Fax: 614-300-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRTP02238560003
License Number StateOH

VIII. Authorized Official

Name: LONNIE JOE CRAFT
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 614-573-1557