Organization
MANTUA PHARMACY INC
Active
Other names
MANTUA STATION DRUG CO.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN R WIGGERS RPH (OWNER)
(330) 274-2209
Entity
Organization
Contact information
Practice address
10870 N. MAIN ST, MANTUA, OH 44255
(330) 274-2209
(330) 274-5220
Mailing address
10870 N. MAIN ST, PO BOX 777, MANTUA, OH 44255
(330) 274-2209
(330) 274-5220
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5492800
—
OH
Enumeration date
01/22/2007
Last updated
05/17/2010
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