Organization
SCHWIETERMAN VILLAGE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK STEPHEN DOMINIK R.PH. (PRESIDENT)
(419) 629-2336
Entity
Organization
Contact information
Practice address
200 W MAIN ST, CRIDERSVILLE, OH 45806-2325
(419) 645-4009
(419) 645-4669
Mailing address
200 W MAIN ST, CRIDERSVILLE, OH 45806-2325
(419) 645-4009
(419) 645-4669
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
021569650
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2618895
—
OH
Enumeration date
08/24/2006
Last updated
04/28/2008
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