Healthcare Provider Details

I. General information

NPI: 1043291784
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 EUCLID AVE JJ10 PHARMACY
CLEVELAND OH
44106-2043
US

IV. Provider business mailing address

9211 EUCLID AVE
CLEVELAND OH
44106-2043
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2100
  • Fax: 216-445-0025
Mailing address:
  • Phone: 216-444-2100
  • Fax: 216-445-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number02-0079600
License Number StateOH

VIII. Authorized Official

Name: MR. TIM LONGVILLE
Title or Position: CHIEF ACCOUNTING OFFICER AND CONTRO
Credential:
Phone: 216-636-7416