Provider Demographics
NPI:1720012958
Name:C & B MAIN DISCOUNT DRUG CENTER, INC
Entity Type:Organization
Organization Name:C & B MAIN DISCOUNT DRUG CENTER, INC
Other - Org Name:MAIN DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-876-1228
Mailing Address - Street 1:8507 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINSMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44428-9333
Mailing Address - Country:US
Mailing Address - Phone:330-876-1228
Mailing Address - Fax:330-876-1229
Practice Address - Street 1:8507 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINSMAN
Practice Address - State:OH
Practice Address - Zip Code:44428-9333
Practice Address - Country:US
Practice Address - Phone:330-876-1228
Practice Address - Fax:330-876-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH023694003336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0529771Medicaid
OH0529771Medicaid
OHMAFV94891Medicare PIN