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General NPI Number Information
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NPI Number | 1265595888
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Entity Type | Organization
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Legal Business Name | CHURCHILLS PERRYSBURG LTD
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 26625 DIXIE HWY
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City | PERRYSBURG
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State | OH
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Zip | 43551-1712
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Country | US
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Telephone | 419-872-6904
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Fax | 419-872-6917
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Provider Business Mailing Address
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Address Line | 26625 DIXIE HWY
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City | PERRYSBURG
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State | OH
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Zip | 43551-1712
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Country | US
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Telephone | 419-872-6904
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Fax | 419-872-6917
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Authorized Official
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Title or Position | PHARMACY MANAGER,PIC,AO
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Name | KIMBERLY JOHNSON
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Credential | RPH
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Telephone | 419-872-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021949950
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License Number State | OH
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