MEDICARE: SOUTH WEBSTER PHARMACY, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	021558550	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	2080399	OTHER		PK

General Provider Information

NPI Number	:	1316051394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH WEBSTER PHARMACY, LLC

Provider Business Mailing Address
First Line	:	741 2ND ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-4001
Country	:	US
Telephone Number	:	740-354-5622
Fax Number	:	740-353-1275

Provider Business Practice Location Address
First Line	:	11016 MAIN ST
Second Line	:
City	:	SOUTH WEBSTER
State	:	OH
Zip	:	45682-7501
Country	:	US
Telephone Number	:	740-778-3784
Fax Number	:	740-778-3782

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL STURGILL
Credential	:	RPH
Telephone Number	:	740-354-5622

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/19/2025

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Directions to “SOUTH WEBSTER PHARMACY, LLC ” Practice Location

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