Provider Demographics
NPI:1861489296
Name:ZELLNER PHARMACY INC
Entity Type:Organization
Organization Name:ZELLNER PHARMACY INC
Other - Org Name:ZELLNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-0077
Mailing Address - Street 1:240 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2701
Mailing Address - Country:US
Mailing Address - Phone:419-447-0077
Mailing Address - Fax:419-447-0177
Practice Address - Street 1:240 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2701
Practice Address - Country:US
Practice Address - Phone:419-447-0077
Practice Address - Fax:419-447-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0215177503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3673426OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH2555168Medicaid
3673426OtherNCPDP PROVIDER IDENTIFICATION NUMBER