Healthcare Provider Details

I. General information

NPI: 1528168192
Provider Name (Legal Business Name): DANA M. ARCHUAL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 BERKSHIRE CLUB DR
CINCINNATI OH
45230-2421
US

IV. Provider business mailing address

2118 BERKSHIRE CLUB DR
CINCINNATI OH
45230-2421
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-0640
  • Fax:
Mailing address:
  • Phone: 513-624-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-12832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: