Provider Demographics
NPI:1275621575
Name:ANTWERP PHARMACY INC
Entity Type:Organization
Organization Name:ANTWERP PHARMACY INC
Other - Org Name:ANTWERP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:419-258-2068
Mailing Address - Street 1:109 S. MAIN ST
Mailing Address - Street 2:PO BOX 246
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-0246
Mailing Address - Country:US
Mailing Address - Phone:419-258-2068
Mailing Address - Fax:419-258-2444
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813-0246
Practice Address - Country:US
Practice Address - Phone:419-258-2068
Practice Address - Fax:419-258-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0211309003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076260OtherPK
OH2111459Medicaid
OH1270720001Medicare NSC