Provider Demographics
NPI:1174673362
Name:BUDERER DRUG CO.
Entity Type:Organization
Organization Name:BUDERER DRUG CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDERER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-873-2800
Mailing Address - Street 1:26611 DIXIE HWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1765
Mailing Address - Country:US
Mailing Address - Phone:419-873-2800
Mailing Address - Fax:419-873-0494
Practice Address - Street 1:26611 DIXIE HWY
Practice Address - Street 2:SUITE 119
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1765
Practice Address - Country:US
Practice Address - Phone:419-873-2800
Practice Address - Fax:419-873-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 3336C0004X, 3336H0001X
OH0211984003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163046Medicaid
OH3668158OtherNCPDP