Provider Demographics
NPI:1730190398
Name:DELPHOS DISCOUNT DRUGS INC
Entity type:Organization
Organization Name:DELPHOS DISCOUNT DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EICKHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:BSPH
Authorized Official - Phone:419-692-3784
Mailing Address - Street 1:660 ELIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-1735
Mailing Address - Country:US
Mailing Address - Phone:419-692-3784
Mailing Address - Fax:419-692-7979
Practice Address - Street 1:660 ELIDA AVE
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-1735
Practice Address - Country:US
Practice Address - Phone:419-692-3784
Practice Address - Fax:419-692-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
OHRTP.021368800-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2398230Medicaid
2078973OtherPK
OH2398230Medicaid