Healthcare Provider Details

I. General information

NPI: 1659640746
Provider Name (Legal Business Name): OHIOGUIDESTONE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-8892
  • Fax: 216-361-9273
Mailing address:
  • Phone: 440-260-8892
  • Fax: 216-361-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPMY.022489300-03
License Number StateOH

VIII. Authorized Official

Name: ANAND PANDYA
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential:
Phone: 440-260-8892