Provider Demographics
NPI:1447392477
Name:DISCOUNT DRUG MART, INC.
Entity Type:Organization
Organization Name:DISCOUNT DRUG MART, INC.
Other - Org Name:DISCOUNT DRUG MART #803
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-725-2340
Mailing Address - Street 1:211 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1331
Mailing Address - Country:US
Mailing Address - Phone:800-434-9440
Mailing Address - Fax:330-725-5780
Practice Address - Street 1:211 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1331
Practice Address - Country:US
Practice Address - Phone:800-434-9440
Practice Address - Fax:330-725-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010021900332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499578Medicaid
OHFV92901Medicare PIN
OH2499578Medicaid
OH2499578Medicaid