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General NPI Number Information
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NPI Number | 1730545229
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Entity Type | Organization
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Legal Business Name | CEDARVILLE HOMETOWN PHARMACY LLC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 63 N. MAIN ST.
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City | CEDARVILLE
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State | OH
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Zip | 45314
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Country | US
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Telephone | 937-766-2273
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Fax | 937-697-5086
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Provider Business Mailing Address
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Address Line | PO BOX 662
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City | CEDARVILLE
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State | OH
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Zip | 45314
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Country | US
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Telephone | 937-766-2273
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Fax | 937-697-5086
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE PERRY
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Credential |
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Telephone | 937-336-3637
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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 | 022553950
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License Number State | OH
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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 |
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License Number State |
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