Healthcare Provider Details

I. General information

NPI: 1073612685
Provider Name (Legal Business Name): MIKE EILERS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST DEPT 119 PHARMACY
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

PO BOX 17930
COVINGTON KY
41017-0930
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 513-475-6974
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-16960
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: