Gromoll Drug Store Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

02-0079650 Issued in OH

Legal business name

GROMOLL DRUG STORE INC

Practice address

109 E Ohio Ave
Sebring, OH 44672-1410

Phone

(330) 938-6670

Fax

(330) 938-6021

NPI assigned

Dec 9, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Raymond J Poorbaugh, RPH

Title

Owner

Phone

(330) 938-6670

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1629138979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 N 15TH ST",
            "city": "SEBRING",
            "state": "OH",
            "postal_code": "44672",
            "telephone_number": "330-938-6670",
            "fax_number": "330-938-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E OHIO AVE",
            "city": "SEBRING",
            "state": "OH",
            "postal_code": "446721410",
            "telephone_number": "330-938-6670",
            "fax_number": "330-938-6021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROMOLL DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-09",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "POORBAUGH",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-938-6670",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OH",
            "license": "02-0079650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3459636",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.