MEDICARE: WSW. INC. DBA DANNER'S DRUG

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	183500000X	Pharmacist		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

General Provider Information

NPI Number	:	1700918141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WSW. INC. DBA DANNER'S DRUG

Provider Business Mailing Address
First Line	:	202 W MAIN ST
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1134
Country	:	US
Telephone Number	:	419-994-3221
Fax Number	:	419-994-4040

Provider Business Practice Location Address
First Line	:	202 W MAIN ST
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1134
Country	:	US
Telephone Number	:	419-994-3221
Fax Number	:	419-994-4040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROGER BICKHART
Credential	:	RPH
Telephone Number	:	419-994-3221

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	08/22/2020

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