Provider Demographics
NPI:1639676141
Name:DISCOUNT DRUG MART INC
Entity Type:Organization
Organization Name:DISCOUNT DRUG MART INC
Other - Org Name:DISCOUNT DRUG MART INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
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:330-725-2340
Mailing Address - Fax:330-764-4857
Practice Address - Street 1:33381 WALKER RD STE C
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1463
Practice Address - Country:US
Practice Address - Phone:216-750-4037
Practice Address - Fax:440-848-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022880100333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177814OtherPK