Healthcare Provider Details

I. General information

NPI: 1457334153
Provider Name (Legal Business Name): STREAMLINE TOTALCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 MAIN ST
COSHOCTON OH
43812-1507
US

IV. Provider business mailing address

PO BOX 1287
COSHOCTON OH
43812-6287
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-1175
  • Fax: 740-622-0715
Mailing address:
  • Phone: 740-622-1175
  • Fax: 740-622-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number020517450
License Number StateOH

VIII. Authorized Official

Name: PHILLIP VON BURG
Title or Position: PRESIDENT
Credential:
Phone: 740-622-1175