NPIMap

Organization Active NPI

Schwieterman's Drug Store Inc

Doing business as Schwieterman Pharmacy

  • Community/Retail Pharmacy
  • Wapakoneta, OH
National Provider Identifier
1174630461
Registry record updated May 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
02-385050 Issued in OH
Legal business name
SCHWIETERMAN'S DRUG STORE INC
Doing business as
Schwieterman Pharmacy
Practice address
1302 Defiance St
Wapakoneta, OH 45895-1081
Phone
(419) 738-5959
Fax
(419) 738-3019
NPI assigned
Aug 24, 2006
Last updated
May 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark Stephen Dominik, R.PH.NPI 1720080757
Title
President
Phone
(419) 629-2336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 02-385050 OH Primary

Addresses

Primary practice location

1302 Defiance St
Wapakoneta, OH 45895-1081

Mailing address

1302 Defiance St
Wapakoneta, OH 45895-1081
Phone (419) 738-5959

Other names 1

  • SCHWIETERMAN PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040923000925 OH Part B Supplier - Mass Immunization (Roster Biller Only) 4981672250 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minster, OH; Wapakoneta, OH; New Bremen, OH; Coldwater, OH

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1302 Defiance St
Wapakoneta, OH 45895
Phone (419) 738-5958

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306108800000",
    "number": "1174630461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 DEFIANCE ST",
            "city": "WAPAKONETA",
            "state": "OH",
            "postal_code": "458951081",
            "telephone_number": "419-738-5959",
            "fax_number": "419-738-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 DEFIANCE ST",
            "city": "WAPAKONETA",
            "state": "OH",
            "postal_code": "458951081",
            "telephone_number": "419-738-5959",
            "fax_number": "419-738-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHWIETERMAN'S DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2011-05-23",
        "status": "A",
        "authorized_official_last_name": "DOMINIK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-629-2336",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "02-385050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCHWIETERMAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wapakoneta, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.