Provider Demographics
NPI:1457399131
Name:DBA EAST MAIN STREET PHARMACY
Entity Type:Organization
Organization Name:DBA EAST MAIN STREET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-252-1998
Mailing Address - Street 1:1336 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2081
Mailing Address - Country:US
Mailing Address - Phone:614-252-1998
Mailing Address - Fax:614-252-3910
Practice Address - Street 1:1336 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2081
Practice Address - Country:US
Practice Address - Phone:614-252-1998
Practice Address - Fax:614-252-3910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H E FLETCHER LIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0210749003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH021074900OtherSTATE PHARMACY LICENSE NUMBER
OH3665582OtherNABP NUMBER
OH2059356Medicaid
OH2059356Medicaid