Provider Demographics
NPI:1851542138
Name:STM MAIL ORDER PHARMACY
Entity Type:Organization
Organization Name:STM MAIL ORDER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WITLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-632-1231
Mailing Address - Street 1:14895 N STATE AVE
Mailing Address - Street 2:UNIT D 1 PO BOX 248
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9747
Mailing Address - Country:US
Mailing Address - Phone:440-632-1231
Mailing Address - Fax:
Practice Address - Street 1:14895 N STATE AVE
Practice Address - Street 2:UNIT D 1
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9747
Practice Address - Country:US
Practice Address - Phone:440-632-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH QUEST PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021792550 02333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy