=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528130317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PD PROVIDERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 W RUSSELL RD
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45365-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-498-4846
-----------------------------------------------------
Fax | 937-498-4851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 W RUSSELL RD
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45365-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | BOB CURLIS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 937-498-4846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 020939800
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------