Provider Demographics
NPI:1992873137
Name:SELMON INC
Entity type:Organization
Organization Name:SELMON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SELMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-472-1991
Mailing Address - Street 1:135 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-1022
Mailing Address - Country:US
Mailing Address - Phone:740-472-1991
Mailing Address - Fax:740-472-0922
Practice Address - Street 1:135 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-1022
Practice Address - Country:US
Practice Address - Phone:740-472-1991
Practice Address - Fax:740-472-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
OH0222695003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079826Medicaid
2138981OtherPK
6753720001Medicare NSC