Provider Demographics
NPI:1841387040
Name:THE DRUGSTORE AT O'BLENESS LLC
Entity Type:Organization
Organization Name:THE DRUGSTORE AT O'BLENESS LLC
Other - Org Name:THE DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZATTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-359-4513
Mailing Address - Street 1:934 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-566-4690
Mailing Address - Fax:740-566-4691
Practice Address - Street 1:934 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-566-4690
Practice Address - Fax:740-566-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2023-02-06
Deactivation Date:2020-11-24
Deactivation Code:
Reactivation Date:2020-12-02
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0216210003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080485OtherPK