Provider Demographics
NPI:1649372889
Name:SCHWIETERMANS VILLAGE
Entity type:Organization
Organization Name:SCHWIETERMANS VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAUER
Authorized Official - Suffix:
Authorized Official - Credentials:RPL
Authorized Official - Phone:419-645-4009
Mailing Address - Street 1:200 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRIDERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45806
Mailing Address - Country:US
Mailing Address - Phone:419-645-4009
Mailing Address - Fax:419-645-4669
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CRIDERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45806
Practice Address - Country:US
Practice Address - Phone:419-645-4009
Practice Address - Fax:419-645-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHB59590236333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2618895Medicaid
OH0311170006Medicare ID - Type Unspecified