Provider Demographics
NPI:1720008022
Name:SCHWIETERMAN'S DRUG STORE INC
Entity Type:Organization
Organization Name:SCHWIETERMAN'S DRUG STORE INC
Other - Org Name:SCHWIETERMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-394-3219
Mailing Address - Street 1:1052 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2446
Mailing Address - Country:US
Mailing Address - Phone:419-394-3219
Mailing Address - Fax:
Practice Address - Street 1:1052 E SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2446
Practice Address - Country:US
Practice Address - Phone:419-394-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-05129003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0673132Medicaid
OH0673132Medicaid