Provider Demographics
NPI:1528078706
Name:SCHWIETERMANS DRUG STORE INC
Entity type:Organization
Organization Name:SCHWIETERMANS DRUG STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-678-3435
Mailing Address - Street 1:404 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1230
Mailing Address - Country:US
Mailing Address - Phone:419-678-3435
Mailing Address - Fax:419-678-8511
Practice Address - Street 1:404 W NORTH ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1230
Practice Address - Country:US
Practice Address - Phone:419-678-3435
Practice Address - Fax:419-678-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0201651503336C0003X, 3336L0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0494219Medicaid
OH0311170004Medicare NSC
OH0311170004Medicare ID - Type Unspecified