=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225136112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THORNVILLE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 N MAIN ST
-----------------------------------------------------
City | THORNVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43076-9444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-246-6511
-----------------------------------------------------
Fax | 740-246-6513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 396
-----------------------------------------------------
City | THORNVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43076-0396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | STACY APPLETON
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 740-246-6511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 021397150
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------