Healthcare Provider Details

I. General information

NPI: 1770514994
Provider Name (Legal Business Name): CUYAHOGA FALLS GENERAL HOSPITAL RETAIL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 23RD ST
CUYAHOGA FALLS OH
44223-1404
US

IV. Provider business mailing address

1900 23RD ST
CUYAHOGA FALLS OH
44223-1404
US

V. Phone/Fax

Practice location:
  • Phone: 330-971-7000
  • Fax: 330-971-7277
Mailing address:
  • Phone: 330-971-7000
  • Fax: 330-971-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN BROCKETTI
Title or Position: VP OF FINANCE, CFO
Credential:
Phone: 330-971-7438