Healthcare Provider Details

I. General information

NPI: 1942804224
Provider Name (Legal Business Name): RICHARD FOSTER BRODERICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2020
Last Update Date: 11/26/2020
Certification Date: 11/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 LINWOOD AVE
CINCINNATI OH
45208-2946
US

IV. Provider business mailing address

3195 LINWOOD AVE
CINCINNATI OH
45208-2946
US

V. Phone/Fax

Practice location:
  • Phone: 513-321-2470
  • Fax:
Mailing address:
  • Phone: 513-321-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03319920
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: