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General NPI Number Information
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NPI Number | 1619994357
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Entity Type | Organization
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Legal Business Name | SCHWIETERMAN'S DRUG STORE INC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 2 N WASHINGTON ST
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City | NEW BREMEN
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State | OH
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Zip | 45869-1113
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Country | US
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Telephone | 419-629-2336
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Fax | 419-629-3026
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Provider Business Mailing Address
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Address Line | 2 N WASHINGTON ST
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City | NEW BREMEN
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State | OH
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Zip | 45869-1113
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Country | US
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Telephone | 419-629-2336
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Fax | 419-629-3026
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK STEPHEN DOMINIK
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Credential | R.PH.
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Telephone | 419-629-2336
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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 | 020125900
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License Number State | OH
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