MEDICARE: PICKERINGTON 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	3336C0003X	Community/Retail Pharmacy	02-618350	OH

General Provider Information

NPI Number	:	1356488985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PICKERINGTON PHARMACY LLC

Provider Business Mailing Address
First Line	:	641 HILL RD N
Second Line	:	SUITE B
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9346
Country	:	US
Telephone Number	:	614-837-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 HILL RD N
Second Line	:	SUITE B
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9346
Country	:	US
Telephone Number	:	614-837-2112
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DALE LEE SCHULTZ
Credential	:	RPH
Telephone Number	:	614-837-2112

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	12/20/2010

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