Provider Demographics
NPI:1902932304
Name:MEDICINE SHOPPE
Entity Type:Organization
Organization Name:MEDICINE SHOPPE
Other - Org Name:LAWRENCE J LEHMAN MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-335-0000
Mailing Address - Street 1:1204 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1655
Mailing Address - Country:US
Mailing Address - Phone:740-335-0000
Mailing Address - Fax:740-335-8888
Practice Address - Street 1:1204 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1655
Practice Address - Country:US
Practice Address - Phone:740-335-0000
Practice Address - Fax:740-335-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020170250333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440151Medicaid
3637038OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3637038OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3637038OtherOTHER ID NUMBER-COMMERCIAL NUMBER