# GROMOLL DRUG STORE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629138979
- **Authorized official:** MR. RAYMOND J POORBAUGH RPH (OWNER)
- **Authorized official phone:** (330) 938-6670

## Contact information

- **Practice address:** 109 E OHIO AVE, SEBRING, OH 44672-1410
- **Practice address phone:** (330) 938-6670
- **Practice address fax:** (330) 938-6021
- **Mailing address:** 227 N 15TH ST, SEBRING, OH 44672
- **Mailing address phone:** (330) 938-6670
- **Mailing address fax:** (330) 938-6021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 02-0079650 | OH | Yes |

## Other

- **Enumeration date:** 12/09/2006
- **Last updated:** 06/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3459636 | — | OH |