Provider Demographics
NPI:1659457422
Name:HURSH DRUG INC
Entity type:Organization
Organization Name:HURSH DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HARLEY
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-524-0521
Mailing Address - Street 1:90 N DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1325
Mailing Address - Country:US
Mailing Address - Phone:419-524-0521
Mailing Address - Fax:419-524-3892
Practice Address - Street 1:90 N DIAMOND ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1325
Practice Address - Country:US
Practice Address - Phone:419-524-0521
Practice Address - Fax:419-524-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 332BX2000X
OH02-00915003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155317OtherANTHEM BC/BS
OH3622746OtherNABP#
OH06069OtherPARAMONT
OH4196507Medicaid
OH000000155317OtherANTHEM BC/BS
OH=========006OtherMEDICAL MUTUAL