Healthcare Provider Details

I. General information

NPI: 1174696975
Provider Name (Legal Business Name): CHILDRENS MEDICAL CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CHILDRENS PLAZA
DAYTON OH
45404-1815
US

IV. Provider business mailing address

ONE CHILDRENS PLAZA
DAYTON OH
45404-1815
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3346
  • Fax:
Mailing address:
  • Phone: 937-641-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY G ALBAUGH
Title or Position: DIRECTOR
Credential:
Phone: 934-641-3346