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Organization
HICKSVILLE PHARMACY & HOME MEDICAL INC
Active
Organization
HICKSVILLE PHARMACY & HOME MEDICAL INC
Active
Other names
HICKSVILLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHON M MYERS (OWNER)
(419) 542-6218
Entity
Organization
Contact information
Practice address
116 E HIGH ST, HICKSVILLE, OH 43526-1107
(419) 542-6218
(419) 542-8246
Mailing address
116 E HIGH ST, HICKSVILLE, OH 43526-1107
(419) 542-6218
(419) 542-8246
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
022091050
OH
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3090560
—
OH
01
—
3613076
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/11/2006
Last updated
03/10/2011
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