Provider Demographics
NPI:1518968668
Name:DRUG STORE PHARMACY INC
Entity Type:Organization
Organization Name:DRUG STORE PHARMACY INC
Other - Org Name:THE DRUG STORE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-868-1685
Mailing Address - Street 1:2940 GROVEPORT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3255
Mailing Address - Country:US
Mailing Address - Phone:614-491-3446
Mailing Address - Fax:614-491-7783
Practice Address - Street 1:2940 GROVEPORT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3255
Practice Address - Country:US
Practice Address - Phone:614-491-3446
Practice Address - Fax:614-497-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X
OHRTP020113350333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074190OtherPK
OH6543682Medicaid
0486230001Medicare NSC