Healthcare Provider Details

I. General information

NPI: 1437668183
Provider Name (Legal Business Name): OHIO NORTHERN UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W LINCOLN AVE
ADA OH
45810
US

IV. Provider business mailing address

525 S MAIN ST
ADA OH
45810-6000
US

V. Phone/Fax

Practice location:
  • Phone: 419-772-3784
  • Fax: 419-772-3783
Mailing address:
  • Phone: 419-772-3784
  • Fax: 419-772-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022816750
License Number StateOH

VIII. Authorized Official

Name: KATIE WESTGERDES
Title or Position: MANAGER OF PHARMACY SERVICES
Credential: R.PH.
Phone: 419-772-2659