Provider Demographics
NPI:1770681827
Name:GRUND DRUG CO
Entity Type:Organization
Organization Name:GRUND DRUG CO
Other - Org Name:H C GRUND DRUG CO INC
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT TREASURER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILITELLO
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:419-332-5585
Mailing Address - Street 1:227 S. FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420
Mailing Address - Country:US
Mailing Address - Phone:419-332-5585
Mailing Address - Fax:419-332-4999
Practice Address - Street 1:227 S. FRONT ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420
Practice Address - Country:US
Practice Address - Phone:419-332-5585
Practice Address - Fax:419-332-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-01462003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3479507Medicaid
OH0584950001Medicare NSC