Provider Demographics
NPI:1083786875
Name:STEELES PHARMACY INC
Entity Type:Organization
Organization Name:STEELES PHARMACY INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KISKADEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-378-6159
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-0119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1221
Practice Address - Country:US
Practice Address - Phone:937-378-6159
Practice Address - Fax:937-378-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OH333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8400840Medicaid
3614648OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3614648OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0473080001Medicare NSC