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General NPI Number Information
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NPI Number | 1417171927
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Entity Type | Organization
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Legal Business Name | SAM'S DRUG MART, LLC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 475 E STATE ST
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City | ALLIANCE
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State | OH
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Zip | 44601-4909
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Country | US
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Telephone | 330-821-1780
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Fax | 330-821-8045
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Provider Business Mailing Address
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Address Line | 475 E STATE ST
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City | ALLIANCE
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State | OH
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Zip | 44601-4909
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Country | US
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Telephone | 330-821-1780
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Fax | 330-821-8045
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAM ANTHONY CALABRETTA JR.
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Credential | R.PH.
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Telephone | 330-821-1780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02-0428650
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License Number State | OH
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