Organization
YOURX STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY HILDEBRAND (OWNER)
(419) 253-3831
Entity
Organization
Contact information
Practice address
27 S MAIN STREET, MARENGO, OH 43334
(419) 253-3831
Mailing address
PO BOX 47, MARENGO, OH 43334-0047
(419) 253-3831
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
020086300
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0288915
—
OH
Enumeration date
11/07/2006
Last updated
01/25/2011
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