Healthcare Provider Details

I. General information

NPI: 1477062289
Provider Name (Legal Business Name): MERCY HEALTH YOUNGSTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

PO BOX 639922
CINCINNATI OH
45263-9922
US

V. Phone/Fax

Practice location:
  • Phone: 513-952-5063
  • Fax:
Mailing address:
  • Phone: 513-952-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY RALSTON
Title or Position: SYSTEM DIRECTO
Credential:
Phone: 419-996-5119