Healthcare Provider Details

I. General information

NPI: 1023732153
Provider Name (Legal Business Name): GIDEON YIADOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7398 WOOSTER PIKE
CINCINNATI OH
45227-3834
US

IV. Provider business mailing address

4236 LONG LAKE DR UNIT 10115
BATAVIA OH
45103-9168
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-3131
  • Fax:
Mailing address:
  • Phone: 513-237-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03442580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: