Pemberville Drug Store LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RTP.022122100-3 Issued in OH

Legal business name

PEMBERVILLE DRUG STORE LLC

Doing business as

Pemberville Drug Store

Practice address

143 E Front St
Pemberville, OH 43450-7032

Phone

(419) 287-3238

Fax

(419) 287-2008

NPI assigned

Nov 15, 2006

Last updated

Jan 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph Baumgartner, PHARMACIST

Title

President

Phone

(419) 287-3238

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Pemberville Drug Store Doing business as

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1881766418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "city": "PEMBERVILLE",
            "state": "OH",
            "postal_code": "434500897",
            "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": "143 E FRONT ST",
            "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": "2006-11-15",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "BAUMGARTNER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-287-3238",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "RTP.022122100-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130702",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010620",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pemberville Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Pemberville, OH
• Providers in Pemberville, OH by specialty
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.