Provider Demographics
NPI:1750677944
Name:BUDERER DRUG COMPANY INC
Entity Type:Organization
Organization Name:BUDERER DRUG COMPANY INC
Other - Org Name:BUDERER DRUG COMPANY, AVON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDERER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-873-2800
Mailing Address - Street 1:38530 CHESTER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4047
Mailing Address - Country:US
Mailing Address - Phone:440-934-3100
Mailing Address - Fax:440-934-3103
Practice Address - Street 1:38530 CHESTER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4047
Practice Address - Country:US
Practice Address - Phone:440-934-3100
Practice Address - Fax:440-934-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 3336C0004X, 3336H0001X
OHSP0221333003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054740Medicaid
OH022133300OtherOHIO STATE BOARD OF PHARMACY TDDD
2130965OtherPK