Pemberville Drug Store LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

022122100 Issued in OH

Legal business name

PEMBERVILLE DRUG STORE LLC

Practice address

139 E Front St # 897
Pemberville, OH 43450-7032

Phone

(419) 287-3238

Fax

(419) 287-2008

NPI assigned

Sep 26, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Joseph Lee Baumgartner, RPH

Title

Owner

Phone

(419) 287-3238

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316995200000",
    "number": "1184907115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 E FRONT ST # 897",
            "city": "PEMBERVILLE",
            "state": "OH",
            "postal_code": "434507032",
            "telephone_number": "419-287-3238",
            "fax_number": "419-287-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 E FRONT ST # 897",
            "city": "PEMBERVILLE",
            "state": "OH",
            "postal_code": "434507032",
            "telephone_number": "419-287-3238",
            "fax_number": "419-287-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBERVILLE DRUG STORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-09-26",
        "status": "A",
        "authorized_official_last_name": "BAUMGARTNER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-287-3238",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OH",
            "license": "022122100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010620",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Long Term Care Pharmacy in Pemberville, OH
• Providers in Pemberville, OH by specialty
• Long Term Care Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.