Healthcare Provider Details

I. General information

NPI: 1952899601
Provider Name (Legal Business Name): SYCAMORE HILLS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9683 KENWOOD RD
BLUE ASH OH
45242-6128
US

IV. Provider business mailing address

9683 KENWOOD RD
BLUE ASH OH
45242-6128
US

V. Phone/Fax

Practice location:
  • Phone: 801-419-9388
  • Fax: 480-393-7663
Mailing address:
  • Phone: 513-327-7200
  • Fax: 513-327-8917

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 Number
License Number State

VIII. Authorized Official

Name: SAVAN NAGRECHA
Title or Position: OWNER
Credential:
Phone: 508-410-9906