Provider Demographics
NPI:1700821717
Name:DISCOUNT DRUG MART INC
Entity Type:Organization
Organization Name:DISCOUNT DRUG MART INC
Other - Org Name:DISCOUNT DRUG MART
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:CPHT
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 1:5378 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9753
Practice Address - Country:US
Practice Address - Phone:614-850-8170
Practice Address - Fax:614-850-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0214727003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535662Medicaid
3673123OtherNCPDP PROVIDER IDENTIFICATION NUMBER
P00046286Medicare PIN
3673123OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0345900063Medicare NSC