Organization
PEMBERVILLE DRUG STORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH LEE BAUMGARTNER RPH (OWNER)
(419) 287-3238
Entity
Organization
Contact information
Practice address
139 E FRONT ST # 897, PEMBERVILLE, OH 43450-7032
(419) 287-3238
(419) 287-2008
Mailing address
139 E FRONT ST # 897, PEMBERVILLE, OH 43450-7032
(419) 287-3238
(419) 287-2008
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
022122100
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010620
—
OH
Enumeration date
09/26/2011
Last updated
09/26/2011
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