Provider Demographics
NPI:1730518796
Name:MAIN STREET PHARMACY & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MAIN STREET PHARMACY & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-466-5063
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1638
Mailing Address - Country:US
Mailing Address - Phone:330-682-2905
Mailing Address - Fax:330-682-2907
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1638
Practice Address - Country:US
Practice Address - Phone:330-682-2905
Practice Address - Fax:330-682-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-10
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy