NPIMap

Organization Active NPI

Wyandot Memorial Hospital

Doing business as Koehler Pharmacy

  • Community/Retail Pharmacy
  • Upper Sandusky, OH
National Provider Identifier
1871254599
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
WYANDOT MEMORIAL HOSPITAL
Doing business as
Koehler Pharmacy
Practice address
425 W Church St
Upper Sandusky, OH 43351-1038
Phone
(419) 294-1916
Fax
(419) 294-0087
NPI assigned
Jan 5, 2022
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WYANDOT MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Mr. Ty R Shaull
Title
President and Ceo
Phone
(419) 294-4991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

425 W Church St
Upper Sandusky, OH 43351-1038

Mailing address

885 N Sandusky Ave
Upper Sandusky, OH 43351-1098
Phone (419) 294-4991

Other practice location 1

107 Houpt Dr
Upper Sandusky, OH 43351-9201
Phone (419) 294-1916

Other identifiers 1

IdentifierTypeStateIssuer
9687512MedicaidOH

Other names 1

  • Koehler Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20220518001936 OH DME Supplier - Medical Supply Company With Registered PharmacistDME Supplier - Pharmacy 1557340189 Practice locations: Upper Sandusky, OH
O20221104000633 OH Part B Supplier - Pharmacy 1557340189 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carey, OH; Forest, OH; Upper Sandusky, OH
O20230807001442 OH Part B Supplier - Mass Immunization (Roster Biller Only) 1557340189 Practice locations: Upper Sandusky, OH

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wyandot Memorial Hospital425 W Church St, Upper Sandusky, OH 43351-1038(419) 294-1916 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Patient Lifts|Walkers|Wh… Accepts assignmentParticipating since Oct 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Wyandot Memorial Hospti10 organizations share this tax ID, including this one
Part of
Wyandot Memorial Hospti

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

136 N Sandusky Ave
Upper Sandusky, OH 43351
Phone (419) 294-1916

425 W Church St
Upper Sandusky, OH 43351
Phone (419) 294-1916

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wyandot Memorial HospitalUpper Sandusky, OH, CCN 361329 Hospital Operational/Managerial Control Jul 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1871254599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 N SANDUSKY AVE",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433511098",
            "telephone_number": "419-294-4991",
            "fax_number": "419-209-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W CHURCH ST",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433511038",
            "telephone_number": "419-294-1916",
            "fax_number": "419-294-0087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 Houpt Dr",
            "address_purpose": "LOCATION",
            "city": "Upper Sandusky",
            "state": "OH",
            "postal_code": "433519201",
            "country_code": "US",
            "telephone_number": "419-294-1916",
            "fax_number": "419-294-0087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WYANDOT MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WYANDOT MEMORIAL HOSPITAL",
        "enumeration_date": "2022-01-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "SHAULL",
        "authorized_official_first_name": "TY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "419-294-4991",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9687512",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koehler Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upper Sandusky, OH

Sources for this page

Verify at the official NPI Registry.