Healthcare Provider Details

I. General information

NPI: 1881519544
Provider Name (Legal Business Name): UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROAD ST STE 109
ELYRIA OH
44035-6429
US

IV. Provider business mailing address

125 E BROAD ST STE 109
ELYRIA OH
44035-6429
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7300
  • Fax: 440-329-7441
Mailing address:
  • Phone: 440-329-7300
  • Fax: 440-329-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHANE BURNSWORTH
Title or Position: PHARMACY SUPERVISOR
Credential: RPH
Phone: 440-935-2753