Healthcare Provider Details

I. General information

NPI: 1396743894
Provider Name (Legal Business Name): SAINT JOSEPH BEREA HOSPITAL OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST
BEREA KY
40403-1742
US

IV. Provider business mailing address

305 ESTILL ST
BEREA KY
40403-1742
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-6541
  • Fax: 859-986-2697
Mailing address:
  • Phone: 859-986-6541
  • Fax: 859-986-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09724
License Number StateKY

VIII. Authorized Official

Name: DR. JOANNE D. O'KANE
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 859-986-6541