Healthcare Provider Details

I. General information

NPI: 1922005453
Provider Name (Legal Business Name): DEBORAH W CALLICOAT C.PH.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 DANBURY RD
CINCINNATI OH
45240-3104
US

IV. Provider business mailing address

704 DANBURY RD
CINCINNATI OH
45240-3104
US

V. Phone/Fax

Practice location:
  • Phone: 513-742-3888
  • Fax: 860-262-9889
Mailing address:
  • Phone: 513-579-3356
  • Fax: 513-579-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number300101041152117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: