Healthcare Provider Details

I. General information

NPI: 1427423193
Provider Name (Legal Business Name): ELMWOOD MANAGEMENT, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ST
GREEN SPRINGS OH
44836-9653
US

IV. Provider business mailing address

401 N BROADWAY ST
GREEN SPRINGS OH
44836-9653
US

V. Phone/Fax

Practice location:
  • Phone: 419-680-8004
  • Fax: 419-639-2519
Mailing address:
  • Phone: 419-680-8004
  • Fax: 419-639-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHOS.022167450
License Number StateOH

VIII. Authorized Official

Name: KATHY KAY HUNT
Title or Position: MANAGER
Credential: LNHA
Phone: 419-639-2581