MEDICARE: MEDICINE STORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3642382	OTHER		NCPDP

General Provider Information

NPI Number	:	1093717043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE STORE

Provider Business Mailing Address
First Line	:	231 N HIGH ST
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-1128
Country	:	US
Telephone Number	:	937-393-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 N HIGH ST
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-1128
Country	:	US
Telephone Number	:	937-393-1996
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	MR. JEFFREY GUY KING
Credential	:	R.PH.
Telephone Number	:	937-393-1996

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	08/22/2020

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Directions to “MEDICINE STORE ” Practice Location

Language	Start Address	Practice Location

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