Provider Demographics
NPI:1013067107
Name:BUDERER DRUG COMPANY INC
Entity Type:Organization
Organization Name:BUDERER DRUG COMPANY INC
Other - Org Name:BUDERER DRUG COMPANY, INC.
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:419-627-2800
Mailing Address - Street 1:633 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3603
Mailing Address - Country:US
Mailing Address - Phone:419-627-2800
Mailing Address - Fax:419-626-0494
Practice Address - Street 1:633 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3603
Practice Address - Country:US
Practice Address - Phone:419-627-2800
Practice Address - Fax:419-626-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
OH0221106900OtherOHIO BOARD OF PHARMACY LICENSE TDDD
2076521OtherPK
OH3098740Medicaid
OH3666801OtherNCPDP
KYOH1830OtherKENTUCKY BOARD OF PHARMACY