Provider Demographics
NPI:1447397443
Name:MECHANICSBURG DRUGGIST LLC
Entity Type:Organization
Organization Name:MECHANICSBURG DRUGGIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-573-1557
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-0126
Mailing Address - Country:US
Mailing Address - Phone:614-573-1557
Mailing Address - Fax:614-300-7558
Practice Address - Street 1:26 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:OH
Practice Address - Zip Code:43044-1111
Practice Address - Country:US
Practice Address - Phone:937-834-2270
Practice Address - Fax:937-834-3906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO APOTHECARIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0203949003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386195Medicaid
OH0624150001Medicare NSC